PERIOPERATIVE STROKE IN CARDIAC-SURGERY

The aim of the study was to identify causes for perioperative stroke i n cardiac surgery in order to reduce its occurrence. From 1989 to 1994 , 3593 open heart operations were performed in adult patients. In 59 p atients carotid endarterectomy for high grade stenosis was combined wi th the cardiac operation. There were a total of 68 (2%) focal strokes, 41 of which were considered minor and 14 major; 13 were lethal. The e tiology of the 27 major and lethal events was most probably an embolus from the ascending aorta (6), from the ascending aorta or a cardiac v alve (5), a thrombus in the left heart (6), air (1), cardiac arrest an d resuscitation (4), cerebral hemorrhage (1), preoperatively unknown b ut high grade internal carotid stenosis (3), and a 50% stenosis of bot h internal carotid arteries preoperatively known but not operated on ( 1). There were 2 minor but no major neurologic complications in patien ts undergoing a combined carotid and cardiac procedure. A wide indicat ion for preoperative neuroangiologic examination, echocardiography and careful intraoperative management may help to identify sources of pos sible emboli. Endarterectomy of high grade carotid stenosis is recomme nded simultaneously with the cardiac procedure.