Stroke after cardiac surgery: Short- and long-term outcomes

Background. Stroke remains a devastating complication of cardiac surgery, b ut stroke prevention remains elusive. Evaluation of early and long-term cli nical outcomes and brain-imaging findings may provide insight into stroke p rognosis, etiology, and prevention. Methods. Five thousand nine hundred seventy-one cardiac surgery patients we re prospectively studied for clinical evidence of stroke. Stroke and nonstr oke patients were compared by early outcomes. Data collected for stroke pat ients included brain imaging results, long-term functional status, and surv ival. Outcome predictors were then determined. Results. Stroke was diagnosed in 214 (3.6%) patients. Brain imaging demonst rated acute infarction in 72%; embolic in 83%, and watershed in 24%. Surviv al for stroke patients was 67% at 1 year and 47% at 5 years. Independent pr edictors of survival were cerebral infarct type, creatinine elevation, card iopulmonary bypass time, preoperative intensive care days, postoperative aw akening time, and postoperative intensive care days. Longterm disability wa s moderate to severe in 69%. Conclusions. Stroke after cardiac surgery has profound repercussions that a re independently related to infarct type and clinical factors. These data a re essential for clinical decision making and prognosis determination. (C) 2001 by The Society of Thoracic Surgeons.