920-48 Influence of Preoperative Risk Factors on Intraoperative and Postoperative Cerebrovascular Accidents in Cardiac Surgery

Abstract

Influence of risk factors on cerebrovascular accidents (CVA) in cardiac surgery has been investigated in several studies, but no one has identified differences in risk factors on intraoperative CVA (I-CVA) and postoperative CVA (P-CVA). I-CVA is identified when evidence of CVA is seen as patient emerges from anesthesia and P-CVA is identified if after emerging from anesthesia normally, signs of CVA then appear. To explore proper preventive strategies for each CVA, data were reviewed in 4351 adult patients who underwent cardiac surgery between 1/1/90 and 6/30194. Sixty (1.38%) patients suffered I-CVA and 53 (1.24%) patients experienced P-CVA. CVA patients are older (I-CVA: 69.6 vs. 64.2, p < 0.001; P-CVA: 70.1 vs. 64.1, P < 0.001) and I-CVA shows a higher proportion of females (45.0% vs. 30.0%. p = 0.01). The rates of I-CVA and P-CVA are 1.48% and 1.34% for isolated CABG patients (n = 3037). 0.28% and 0.70% for isolated valve patients (n = 713). 1.90% and 1.69% for patients who undervvent combined procedures (n = 422), 2.79% and 0.57% for other surgeries (n = 179). Patient age (p < 0.001) and proportion of females (p < 0.0011 differed by procedures (CABG: 64.6 ± 10.4.25.0%; Valve: 60.4 ± 15.7.46.1%; CABG + Valve: 704 ± 9.0, 34.8%; others: 58.4 ± 16.2.44.7%). In order to adjust influence of preoperative risk factors on each CVA. stepwise logistic regression was applied to a subset of isolated CABGs. Intraoperative CVA Postoperative CVA Risk Factor Odds Ratio p Risk Factor Odds Ratio p Carotid Disease 4.81 <0.001 Prior Stroke 7.33 <0.001 Renal Disease 4.04 <0.001 Refuse blood 6.68 0.003 Diabetes 2.62 0.003 Cardiac Arrest 6.60 <0.001 MI ≥ 30 Days 2.50 0.103 Carotid Disease 3.61 0.012 Age ≤ 65 Years 1.91 0.074 Cardiogenic Shock 3.02 0.014 Female Gender 1.80 0.063 Age≥ 75 Years 2.05 0.041 (1) The risk of I-CVA or P-CVA is higher for CABG procedures, with or without associated valve procedure, than for isolated valve procedures. (2) Patient age is a predictor for I-CVA and P-CVA. (3) There may be a slightly increased risk for I-CVA in females.