Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Ann Thorac Surg. 2020 Aug;110(2):448-456. doi: 10.1016/j.athoracsur.2020.02.025. Epub 2020 Mar 19.
Stroke is a major complication after cardiac surgery causing increased morbidity and mortality. There are limited data on outcomes of patients with large vessel occlusion after cardiac surgery.
Patients who underwent index cardiac surgeries as defined by The Society of Thoracic Surgeons (STS) from 2010 to 2017 were reviewed from a prospectively maintained database. All patients with neurologic deficits were identified, and only patients with ischemic strokes were included.
A total of 10,250 patients underwent cardiac surgical procedures. Postoperative stroke with neurologic deficits occurred in 221 patients (2.16%). Of these, 53 patients (24%) had large vessel occlusion. Patients who had a postoperative stroke were older and more likely to be female. These patients had higher STS predicted mortality and longer bypass time, cross-clamp time, total intensive care unit stay, and total hospital stay. Operative mortality was significantly higher for patients who had postoperative stroke (14.93% vs 2.15%, P < .001). Kaplan-Meier survival estimates demonstrated worse survival for the large vessel occlusion cohort at 1 year (54.72% vs 75%, P = .002). Predictors of stroke included increasing age, known cerebrovascular disease, diabetes mellitus, and emergent operative status. The most significant predictors of operative mortality included emergent operative status and New York Heart Association stage IV heart failure. There was no difference in 30-day, 1-year, and 5-year mortality between the intervention group and the medically managed patients in the large vessel occlusion cohort.
Stroke is a devastating complication after cardiac surgery that increases operative morbidity and mortality. Stroke with large vessel occlusion was associated with worse survival. However, early intervention did not impart a survival benefit.
中风是心脏手术后的主要并发症，会增加发病率和死亡率。关于心脏手术后大血管闭塞患者的结局数据有限。
从一个前瞻性维护的数据库中回顾了 2010 年至 2017 年期间接受胸外科医师学会（STS）定义的指数心脏手术的患者。所有有神经功能缺损的患者都被识别出来，只有缺血性中风的患者被包括在内。
共有 10250 例患者接受了心脏手术。术后出现神经功能缺损的中风患者共 221 例（2.16%）。其中 53 例（24%）患者有大血管闭塞。发生术后中风的患者年龄较大，更可能为女性。这些患者 STS 预测死亡率更高，体外循环时间、主动脉阻断时间、重症监护病房总停留时间和总住院时间更长。术后发生中风的患者手术死亡率明显更高（14.93% vs. 2.15%，P<.001）。Kaplan-Meier 生存估计表明，大血管闭塞组 1 年生存率较差（54.72% vs. 75%，P=.002）。中风的预测因素包括年龄增长、已知的脑血管疾病、糖尿病和紧急手术状态。手术死亡率的主要预测因素包括紧急手术状态和纽约心脏协会心功能 IV 级心力衰竭。在大血管闭塞组中，干预组和药物治疗组在 30 天、1 年和 5 年死亡率方面没有差异。
中风是心脏手术后的一种破坏性并发症，增加了手术发病率和死亡率。大血管闭塞伴中风与生存率降低相关。然而，早期干预并未带来生存获益。
