Introduction
Perioperative stroke is a devastating complication following cardiac
surgery, with an incidence reported to be between 0.8% -
5.2%1. It is a cause of significant morbidity and
mortality in the perioperative period, with associated financial impact
due to prolonged hospital admission and ongoing rehabilitation
requirements2. Perioperative stroke is diagnosed at
two timepoints following cardiac surgery: on waking from anaesthesia or
several days later and are believed to have different mechanisms. Early
strokes, where patients are found to have neurological deficits or are
slow to wake following cessation of sedation in the intensive care unit,
are thought to be associated with embolism related to aortic and cardiac
manipulation intraoperatively. Delayed strokes occurring following full
recovery from anaesthesia are thought to be related to atrial
fibrillation, cerebrovascular disease (carotid artery atherosclerosis or
small vessel disease) or low output states3.
A number of risk factors have been identified for the development of
stroke following cardiac surgery and some have attempted to create
models to quantify risk2,4,5. The challenge though is
that many of these factors such as: age, diabetes, smoking history,
chronic obstructive pulmonary disease and peripheral arterial disease
are common to the development of cardiovascular disease and therefore
the indication for cardiac surgery.
Over recent years, the population of patients undergoing cardiac surgery
has changed: they are older and suffer more comorbidity and are having
more complex surgery. The aim of this work was to evaluate the
epidemiology and clinical impact of stroke in a contemporary population
undergoing cardiac surgery at a high-volume centre.