Neurological complications after cardiac surgery: a retrospective case-control study of risk factors and outcome

Journal of Cardiothoracic Surgery

Giuseppe Maria Raffa¹  Michele Pilato¹  Giovanna Occhipinti²  Antonio Arcadipane²  Francesco Agnello³  Angelo Luca³  Roberto Miraglia³  Gianluca Marrone³  Vincenzina Lo Re⁴  Fabio Tuzzolino⁵ 

[1] Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS – ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione);Department of Anesthesia and Critical Care, IRCCS – ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione);Diagnostic and Therapeutic Services, Radiology Unit, IRCCS – ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione);Neurology Service, Department of Diagnostic and Therapeutic Services, IRCCS – ISMETT;Statistician, Research Office, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies);

关键词: Atherosclerosis;    Carotid arteries;    CT-scan;    MRI;    Neurocognitive deficits;    Cardiac surgery;   

DOI  :  10.1186/s13019-019-0844-8

来源: DOAJ

【 摘 要 】

Abstract Background To evaluate incidence, risk factors, and outcomes of postoperative neurological complications in patients undergoing cardiac surgery. Methods A total of 2121 patients underwent cardiac surgery between August, 2008 and December, 2013; 91/2121 (4.3%) underwent brain computed tomography (70/91, 77%) or magnetic resonance imaging (21/91, 23%) scan because of major stroke (37/2121, 1.7%) and a spectrum of transient neurological episodes as well as transient ischemic attacks and delirium /psychosis/seizures (54/2121, 2.5%). The mean age was 65.3 ± 12.1 years and 60 (65.9%) were male. Variables were compared among study- and matched-patients (n = 113) without neurological deficits. Results A total of 37/2121 (1.7%) patients had imaging evidence of stroke. Radiological examinations were done 5.72 ± 3.6 days after surgery. Patients with and without imaging evidence of stroke had longer intensive care unit length of stay (LOS) (13.8 ± 14.7 and 12.9 ± 15 days vs. 5.7 ± 12.1 days, respectively (p < 0.001) and hospital LOS (53 ± 72.8 and 35.5 ± 29.8 days vs. 18.4 ± 29.2 days, respectively (p < 0.001) than the control group. The hospital mortality of patients with and without imaging evidence of stroke was higher than the control group (7/37 patients [19%], and 12/54 patients [22%] vs. 4/115 patients [3%], respectively (p < 0.001). Multivariate analysis showed that bilateral internal carotid artery stenosis of any grade (p < .001), and re-do operations (p = .013) increased the risk of postoperative neurological complications. Conclusions Neurological complications after cardiac surgery increase hospitalization and mortality even in patients without radiologic evidence of stroke. Bilateral internal carotid artery stenosis of any grade, suggesting a diffuse patient propensity toward atherosclerosis, and re-do operations increase the risk of postoperative neurological complications.

【 授权许可】

Unknown