Karunanantham Jayenthan, Ali Jason M, Evans Nicholas R, Webb Stephen, Large Stephen R
Department of Cardiothoracic Surgery, University of Cambridge, Cambridge, UK.
Department of Stroke Medicine, University of Cambridge, Cambridge, UK.
J Card Surg. 2020 Nov;35(11):3010-3016. doi: 10.1111/jocs.14964. Epub 2020 Aug 16.
Stroke remains a devastating complication of cardiac surgery. The aim of this study was to characterize the incidence of stroke and analyze the impact of stroke on patient outcomes and survival.
A retrospective analysis was performed of patients with a computed tomography-confirmed stroke diagnosis between 1 January 2015 and 31 March 2019 at a single center. 2:1 propensity matching was performed to identify a control population.
Over the period 165 patients suffered a stroke (1.99%), with an incidence ranging from 0.85% for coronary artery bypass grafting to 8.14% for aortic surgery. The mean age was 70.3 years and 58.8% were male. 18% had experienced a previous stroke or transient ischemic attack. Compared to the comparison group, patients experiencing postoperative stroke had a significantly prolonged period of intensive care unit admission (8.0 vs 1.1 days P < .001) and hospital length of stay (12.94 vs 8.0 days P < .001). Patient survival was also inferior. In-hospital mortality was almost three times as high (17.0% vs 5.9%; P < .001). Longer-term survival was also inferior to Kaplan-Meier estimation (P < .001). The 1-year and 3-year survival were 61.5% and 53.8% respectively compared to 89.4% and 86.1% for the comparison group.
Perioperative stroke is a devastating complication following cardiac surgery. Perioperative stroke is associated with significantly inferior outcomes in terms of both morbidity and mortality. Notably a 28% reduction in 1-year survival. Efforts should focus on identifying strategies aimed at reducing the incidence, morbidity, and mortality of perioperative stroke following cardiac surgery.
中风仍然是心脏手术的一种毁灭性并发症。本研究的目的是确定中风的发生率，并分析中风对患者预后和生存的影响。
对2015年1月1日至2019年3月31日在单一中心经计算机断层扫描确诊为中风的患者进行回顾性分析。采用2:1倾向匹配法确定对照组。
在此期间，165例患者发生中风（1.99%），发生率从冠状动脉搭桥术的0.85%到主动脉手术的8.14%不等。平均年龄为70.3岁，58.8%为男性。18%的患者曾有过中风或短暂性脑缺血发作。与对照组相比，术后发生中风的患者重症监护病房住院时间显著延长（8.0天对1.1天，P < 0.001），住院时间也延长（12.94天对8.0天，P < 0.001）。患者生存率也较低。住院死亡率几乎高出两倍（17.0%对5.9%；P < 0.001）。长期生存率也低于Kaplan-Meier估计值（P < 0.001）。1年和3年生存率分别为61.5%和53.8%，而对照组分别为89.4%和86.1%。
围手术期中风是心脏手术后的一种毁灭性并发症。围手术期中风在发病率和死亡率方面均与明显较差的预后相关。值得注意的是，1年生存率降低了28%。应致力于确定旨在降低心脏手术后围手术期中风的发生率、发病率和死亡率的策略。
