Incidence and predictors of postoperative ischemic stroke after coronary artery bypass grafting (original) (raw)

Background: The recognition of the impact of new medications and the synergic effect of new drug combinations is absent in studies comparing coronary artery bypass grafting surgery (CABG) with medical therapy. There are limited review data regarding the contribution of morbidities after CABG on outcomes.

Cardiovascular disease remains the leading cause of death among adults aged 65 and over in the United States and other Western populations. As the older age group continues to increase rapidly, the treatment of cardiovascular disease will become an increasingly important factor in the health of older persons. In fact, of the over 6 million cardiovascular procedures performed during 2002 in the United States, more than half were carried out in patients aged 65 or over. 1,2 Cardiovascular surgical interventions are offered to older patients to improve both length and quality of life. The challenges of thoracic aortic procedures and of providing surgical therapy for coronary artery disease (CAD) and valvular disease in older patients are increasing. The field of cardiac surgery faces a demand for continual improvement in the processes and structures of care to address the unique problems encountered in older patients undergoing cardiac surgery. This chapter updates the research agenda ...

Current data suggest that cardiac bypass surgery is the single largest cause of iatrogenic stroke. Among the strategies to decrease or eliminate aortic manipulation, there is the use of off-pump coronary artery bypass grafting (CABG) through an aortic “no touch” technique, which reduces significantly the stroke rate. However, this off-pump aortic “no touch” technique is not always applicable, and, when saphenous vein and/or free arterial aortocoronary grafts are used, there is still risk of neurological injury due to tangential aortic clamp applied during the proximal anastomosis sewing. We aim to analyze the current incidence, etiology, and physiopathology of the neurological complications after coronary artery bypass surgery. We describe the methods and techniques that provide reduction in the occurrence of neurological complications. CABG with multiple clamp technique failed to find a better outcome in terms of neuropsychological deficit in the OPCABG group. By the way, patients ...

Objective Octogenarians, as the fastest growing stratum of the population and with the highest prevalence of coronary artery disease, are being increasingly referred for coronary artery bypass grafting (CABG). The general perception is that the presence of comorbidities and the propensity for neurological injury expose them to a higher risk for mortality and morbidity after conventional on-pump CABG, and therefore, off-pump CABG should be preferentially offered to octogenarians to improve outcomes. This study evaluates the in-hospital outcomes and predictors of mortality and stroke in octogenarians undergoing on- and off-pump CABG at our institution. Methods From January 2000 to December 2010, a total of 290 octogenarians underwent off-pump (n = 217) and on-pump (n = 73) CABG. Their data were prospectively entered into the cardiac surgery database (Patients Analysis & Tracking System; Dendrite Clinical Systems, Ltd, Oxford, England, United Kingdom) and analyzed retrospectively. Outc...

Introduction: Patients who undergo myocardial revascularization procedures (CABG) are prone to neurologic dysfunction. Significant neurologic problems implicate a higher mortality rate and permanent functional deficiencies. Objective: The aim of this study was to evaluate the incidence and to identify possible predictors of major postoperative neurologic dysfunction (defined as stroke) and to evaluate early clinical outcomes in a non-selected cohort. Method: