Predictors and Outcomes of Ischemic Stroke After Cardiac Surgery

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.