Stroke is a known complication after aortic surgery. The contributing factors for this complication are not well defined.
Between the years 1990 and 2000, 267 patients underwent aortic surgery at our institution. Prospectively collected data (for reporting to the New York State Cardiac Surgery Registry) were used to analyze risk factors for stroke.
Mean age was 60±13 years. Surgery type includes replacement of: ascending aorta 35.2%, aortic root and ascending aorta (Bentall procedure) 41.6%, aortic arch 2.8%, and descending aorta 20.2%. Twenty one percent patients had concomitant procedures on the heart, and 18.7% patients had previous heart surgery. Hypothermic circulatory arrest (HCA) was used in 37.8% patients. Overall 22 patients had post-operative stroke (8.2%). Fifteen patients had stroke within 24 hours of surgery while 7 patients had stroke 24 hours after surgery. Of 30 pre-operative and intra-operative risk factors, we identified 6 to be independent predictors of stroke: history of Chronic obstructive pulmonary disease (COPD, p<0.005), cerebral vascular disease (CVD, p<0.015), peripheral vascular disease (PVD, p<0.048), chronic renal failure (CRF, p<0.019), congestive heart failure (CHF, p<0.038) and smoking (p<0.044).
Although CVD, PVD, CRF, CHF, and smoking are known to be risk factors for stroke after aortic surgery, COPD is the most significant predictor for stroke in our series. This relationship has not been addressed in the literature. For strokes occurring after 24 hours, peripheral vascular disease including diseased aorta is the only independent risk factor.
This study suggests that optimizing patients with COPD in peri-operative period may reduce the risk of stroke from aortic surgery.
Zhandong Zhou, None.