Neurological complications after cardiac surgery: a retrospective case-control study of risk factors and outcome

• Main Authors: Giuseppe Maria Raffa, Francesco Agnello, Giovanna Occhipinti, Roberto Miraglia, Vincenzina Lo Re, Gianluca Marrone, Fabio Tuzzolino, Antonio Arcadipane, Michele Pilato, Angelo Luca
• Format: Article
• Language: English
• Published: BMC 2019-01-01
• Series: Journal of Cardiothoracic Surgery
• Subjects: Atherosclerosis; Carotid arteries; CT-scan; MRI; Neurocognitive deficits; Cardiac surgery
• Online Access: http://link.springer.com/article/10.1186/s13019-019-0844-8

Abstract Background To evaluate incidence, risk factors, and outcomes of postoperative neurological complications in patients undergoing cardiac surgery. Methods A total of 2121 patients underwent cardiac surgery between August, 2008 and December, 2013; 91/2121 (4.3%) underwent brain computed tomography (70/91, 77%) or magnetic resonance imaging (21/91, 23%) scan because of major stroke (37/2121, 1.7%) and a spectrum of transient neurological episodes as well as transient ischemic attacks and delirium /psychosis/seizures (54/2121, 2.5%). The mean age was 65.3 ± 12.1 years and 60 (65.9%) were male. Variables were compared among study- and matched-patients (n = 113) without neurological deficits. Results A total of 37/2121 (1.7%) patients had imaging evidence of stroke. Radiological examinations were done 5.72 ± 3.6 days after surgery. Patients with and without imaging evidence of stroke had longer intensive care unit length of stay (LOS) (13.8 ± 14.7 and 12.9 ± 15 days vs. 5.7 ± 12.1 days, respectively (p < 0.001) and hospital LOS (53 ± 72.8 and 35.5 ± 29.8 days vs. 18.4 ± 29.2 days, respectively (p < 0.001) than the control group. The hospital mortality of patients with and without imaging evidence of stroke was higher than the control group (7/37 patients [19%], and 12/54 patients [22%] vs. 4/115 patients [3%], respectively (p < 0.001). Multivariate analysis showed that bilateral internal carotid artery stenosis of any grade (p < .001), and re-do operations (p = .013) increased the risk of postoperative neurological complications. Conclusions Neurological complications after cardiac surgery increase hospitalization and mortality even in patients without radiologic evidence of stroke. Bilateral internal carotid artery stenosis of any grade, suggesting a diffuse patient propensity toward atherosclerosis, and re-do operations increase the risk of postoperative neurological complications.