Independent Predictors of Postoperative Stroke With Cardiopulmonary Bypass

Abstract

Objective: To assess predictive factors of postoperative stroke in cardiac surgery using cardiopulmonary bypass (CPB).

Design: This study was a retrospective observational study.

Setting: This study was conducted at a single institution (Liverpool Hospital, NSW, Australia).

Participants: All patients with CPB treated surgically at Liverpool Hospital, NSW, between January 2016 and December 2018 INTERVENTIONS: Patients underwent cardiac surgery with CPB.

Measurements and main results: The primary outcome was cerebrovascular accident, or stroke. Univariate and multivariate analyses via Firth's logistic regression with regard to stroke were performed. The study comprised 1,092 patients over a three-year period. In this cohort, the stroke rate was 3.1%. Via univariate analysis of factors in relation to stroke post-CPB, recent or past stroke (odds ratio [OR] 5.43 v 2.32), diabetes mellitus (OR 1.92), dialysis dependence (OR 5.67), elective procedures (OR 0.34), aortic procedures (OR 4.02), bypass and cross-clamp times (OR 1.02 and 1.04), postoperative atrial fibrillation (OR 2.28), and hypoperfusion times all reached the significance level of p ≤ 0.1 to be included in the multivariate analysis. Multivariate analysis to find independent factors in relation to stroke yielded diabetes mellitus (OR 2.49; p = 0.025), dialysis dependence (OR 3.82; p = 0.03), aortic procedures (OR 3.93; p = 0.014), and elective procedures (OR 0.24; p = 0.026) as independently predictive or protective with regard to postoperative stroke.

Conclusions: Independent predictors of stroke in this single center cohort included dialysis dependence, diabetes, and aortic procedures. Elective procedures were shown to be an independent protective factor.

Keywords: CPB; CVA; cardiac anesthesia; cardiopulmonary bypass; cerebrovascular accident; perfusion pressures; predictors; risk factors; stroke.