Udesh Reshmi, Mehta Amol, Gleason Thomas, Thirumala Parthasarathy D
Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Clin Neurosci. 2017 Aug;42:91-96. doi: 10.1016/j.jocn.2017.04.006. Epub 2017 Apr 25.
To study the role of carotid stenosis (CS) and cerebrovascular disease as independent risk factors for perioperative stroke following surgical aortic valve replacement (SAVR). The National Inpatient Sample (NIS) database was used for our study. All patients who underwent SAVR from 1999 to 2011 were identified using ICD-9 codes. Univariate and multivariate analysis of baseline characteristics, Elixhauser comorbidities and other covariates were examined to identify independent predictors of perioperative strokes following SAVR. Data on 50,979 patients who underwent SAVR from 1999 to 2011 was obtained. The mean age of the study cohort was 60.5. The study patients were predominantly Caucasian (79.3%) and males (60.01%). The incidence of perioperative stroke was 2.48%. CS (OR 1.8, 95%CI 1.1-2.8, p=0.009) and cerebral arterial occlusion (OR 3.4, 95% CI 1.3-8.9) significantly increased perioperative stroke risk following SAVR. Infective endocarditis (OR 4.6, 95%CI 3.8-5.6, p=0.00) and neurological disorders (OR 4.8, 95% CI 4-5.8, p=0.00) appeared to be the strongest risk factors for strokes. Other risk factors found to be significant predictors of perioperative strokes (p<0.05) were - age, higher VWR scores, CS, cerebral arterial occlusion, infective endocarditis, DM, HTN, renal failure, neurological disorders, coagulopathy and hypothyroidsm. In conclusion, perioperative stroke risk has remained more or less constant despite advancements in surgical techniques with risk having gone up in patients <65years of age. CS and cerebral arterial occlusion significantly increase stroke risk following SAVR. Improved patient selection with pre-operative risk stratification and institution of preventive strategies are necessary to improve operative outcomes following SAVR.
研究颈动脉狭窄（CS）和脑血管疾病作为外科主动脉瓣置换术（SAVR）围手术期卒中独立危险因素的作用。我们的研究使用了国家住院患者样本（NIS）数据库。利用国际疾病分类第九版（ICD - 9）编码识别1999年至2011年期间所有接受SAVR的患者。对基线特征、埃利克斯豪泽共病及其他协变量进行单因素和多因素分析，以确定SAVR后围手术期卒中的独立预测因素。获取了1999年至2011年期间50979例接受SAVR患者的数据。研究队列的平均年龄为60.5岁。研究患者主要为白种人（79.3%）且男性居多（60.01%）。围手术期卒中的发生率为2.48%。CS（比值比1.8，95%置信区间1.1 - 2.8，p = 0.009）和脑动脉闭塞（比值比3.4，95%置信区间1.3 - 8.9）显著增加SAVR后围手术期卒中风险。感染性心内膜炎（比值比4.6，95%置信区间3.8 - 5.6，p = 0.00）和神经疾病（比值比4.8，95%置信区间4 - 5.8，p = 0.00）似乎是卒中的最强危险因素。发现的其他围手术期卒中显著预测因素（p < 0.05）包括年龄、较高的VWR评分、CS、脑动脉闭塞、感染性心内膜炎、糖尿病、高血压、肾衰竭、神经疾病、凝血障碍和甲状腺功能减退。总之，尽管手术技术有所进步，但围手术期卒中风险或多或少保持不变，6岁以下患者的风险有所上升。CS和脑动脉闭塞显著增加SAVR后的卒中风险。改善患者选择、进行术前风险分层并制定预防策略对于改善SAVR后的手术结果很有必要。
