Stroke and Cardiac Surgery: Uncovering Predictors and Outcomes of Postoperative Stroke After Cardiac Surgery

November 20, 2020

A new study from a multidisciplinary group of UPMC Heart and Vascular Institute (HVI) and Department of Neurology researchers probed the predictive factors and their impact on ischemic stroke outcomes after cardiac surgery. The study, "Predictors and Outcomes of Ischemic Stroke After Cardiac Surgery,” was published in August in the journal Annals of Thoracic Surgery. Ibrahim Sultan, MD, FACS, FACC, associate professor of cardiothoracic surgery, director of the Center for Thoracic Aortic Disease, and co-director of the Center for Transcatheter Aortic Valve Therapy at the UPMC HVI was the lead author of the new investigation.

The study derived data from a prospective database of patients who underwent cardiac surgery between 2010-2017 at UPMC and experienced a subsequent ischemic stroke.

During the study period, 10,250 index* cardiac surgeries were performed. Upon analysis, 221 patients were found to have had a postoperative stroke with neurologic deficits, 53 of whom were found to have a large vessel occlusion (LVO). All strokes were ischemic or thromboembolic in nature. Hemorrhagic strokes were not included in this study.

*Index procedures included in this study were isolated coronary artery bypass graft (CABG), isolated AV replacement (AVR), isolated MV replacement, isolated MV repair, CABG plus AVR, CABG plus MV replacement, and CABG plus MV repair.

Predictors and Outcomes

Patients in the postoperative stroke group were more likely to be older and female. These individuals also exhibited lengthier hospital stays, more time in the ICU, extended bypass and cross-clamp times, and a Society of Thoracic Surgeons (STS) predicted mortality score.

Those who suffered a postoperative stroke tended to have more presurgical morbidities. Preoperative morbidities included: hypertension, diabetes, peripheral vascular disease, cerebrovascular disease, previous CABG, carotid stenosis, New York Heart Association Class III or IV heart failure.

Individuals in the postoperative stroke cohort who experienced a large vessel occlusion had worse outcomes than those who did not; individuals who experienced a stroke had much higher operative mortality rates. The most significant factors affecting operative mortality were stage IV heart failure and emergency cases of cardiac surgery.

Cardiac surgery patients who experienced a postoperative stroke also were found to experience higher rates of sepsis, pneumonia, renal failure, reoperations, blood transfusions, and prolonged time on a ventilator. 

As may be expected, mortality and readmission rates at the 1-year and five-year follow-up for individuals who had a postoperative stroke were significantly increased over their nonstroke counterparts.

30-day readmissions between the two groups showed no statistically significant differences.

Reference and Further Reading

Complete details and statistics from the study can be viewed at the following reference and link:

Sultan I, Bianco V, Kilic A, Jovin T, Jadhav A, Jankowitz B, Aranda-Michel E, D’angelo MP, Navid F, Wang Y, Thoma F, Gleason TG. Predictors and Outcomes of Ischemic Stroke After Cardiac Surgery. 2020; 110(2): 448-456.