Stroke prevention in cardiac surgery

This article addresses the main risk factors for stroke in cardiac surgery and discusses the role of carotid artery intervention and peri-operative epi-aortic scanning in the prevention of stroke. In great Britain and Northern Ireland, there were ∼2789 new strokes following the 105,558 cases of cardiac surgery from 2004 to 2008 (an annual stroke rate of 2.6% complicating heart surgery in the UK). We argue that The National Health Service in the UK is set to spend £187,682 preventing each stroke in some 30 cardiac surgical patients while ignoring the remaining 528 strokes that complicate cardiac surgery in the UK each year. Caution must be taken in pricing the prevention of perioperative stroke as we must question our use of finite resources. Aortic atheroma has been demonstrated as the foremost cause of post-coronary artery bypass graft strokes. Epi-aortic scanning is effective in identifying aortic atheroma encouraging measures to reduce perioperative stroke with heart surgery, and it is cheap. Several studies have confirmed epi-aortic scanning at the time of heart surgery to be effective in reducing the incidence of perioperative brain damage. We suggest that it is time to adopt epi-aortic scanning in our routine cardiac surgical practice if only to confirm or refute its cost-effectiveness in brain protection during this surgery.