Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
Eur J Clin Invest. 2024 Oct;54(10):e14275. doi: 10.1111/eci.14275. Epub 2024 Jun 29.
Post-cardiac and aortic surgery stroke is often underreported. We detail our single-centre experience the following introduction of comprehensive consultant-led daily stroke service, to demonstrate the efficacy of a stroke team in recovery from stroke following cardiac and aortic surgeries.
This retrospective, single-centre observational cohort study analysed consecutive patients undergoing cardiac and aortic surgery at our institution from August 2014 to December 2020. Main outcomes included stroke rate, predictors of stroke, and neurological deficit resolution or persistence at discharge and clinic follow-up.
A total of 12,135 procedures were carried out in the reference period. Among these, 436 (3.6%) suffered a stroke. Overall survival to discharge and follow-up were 86.0% and 84.0% respectively. Independent risk factors for post-operative stroke included advanced age (OR 1.033, 95% CI [1.023, 1.044], p < .001), female sex (OR 1.491, 95% [1.212, 1.827], p < .001), history of previous cardiac surgeries (OR 1.670, 95% CI [1.239, 2.218], p < .001), simultaneous coronary artery bypass graft + valve procedures (OR 1.825, 95% CI [1.382, 2.382], p < .001) and CPB time longer than 240 min (OR 3.384, 95% CI [2.413, 4.705], p < .001). Stroke patients managed by the multidisciplinary team demonstrated significantly higher rates of survival at discharge (87.3% vs. 61.9%, p = .001).
Perioperative stroke can be debilitating immediately long term. The involvement of specialist stroke teams plays a key role in reducing the long-term burden and mortality of this condition.
心脏和主动脉手术后的脑卒中常常报道不足。我们详细介绍了我们的单中心经验，即引入全面的顾问主导的日常脑卒中服务，以证明脑卒中团队在心脏和主动脉手术后脑卒中恢复方面的疗效。
这是一项回顾性、单中心观察性队列研究，分析了 2014 年 8 月至 2020 年 12 月在我们机构接受心脏和主动脉手术的连续患者。主要结果包括脑卒中发生率、脑卒中的预测因素，以及出院和临床随访时的神经功能缺损的缓解或持续情况。
在参考期间共进行了 12135 例手术。其中，436 例（3.6%）发生了脑卒中。出院和随访时的总生存率分别为 86.0%和 84.0%。术后脑卒中的独立危险因素包括高龄（OR 1.033，95%CI[1.023，1.044]，p<0.001）、女性（OR 1.491，95%[1.212，1.827]，p<0.001）、既往心脏手术史（OR 1.670，95%CI[1.239，2.218]，p<0.001）、同时进行冠状动脉旁路移植术+瓣膜手术（OR 1.825，95%CI[1.382，2.382]，p<0.001）和体外循环时间超过 240 分钟（OR 3.384，95%CI[2.413，4.705]，p<0.001）。由多学科团队管理的脑卒中患者出院时的生存率显著更高（87.3% vs. 61.9%，p=0.001）。
围手术期脑卒中会立即造成长期残疾。专家脑卒中团队的参与对于降低这种疾病的长期负担和死亡率起着关键作用。
