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J Thorac Cardiovasc Surg 2005;129:591-598
© 2005 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Side differences in cerebrovascular accidents after cardiac surgery: A statistical analysis of neurologic symptoms and possible implications for anatomic mechanisms of aortic particle embolization

Department of Surgical and Perioperative Science, Heart Center, Cardiothoracic Division, Umeå University Hospital, Umeå, Sweden

Received for publication March 18, 2004; revisions received July 6, 2004; accepted for publication July 15, 2004.

^* Address for reprints: Patrik Boivie, MD, Department of Surgical and Perioperative Science, Heart Center, Cardiothoracic Division, Umeå University Hospital, S-901 85 Umeå, Sweden (E-mail: patrik_boivie{at}hotmail.com).

BACKGROUND: Aortic manipulation and particle embolization have been identified to cause cerebrovascular accidents in cardiac surgery. Recent data suggest that left-hemispheric cerebrovascular accident (right-sided symptoms) is more common, and this has been interpreted as being caused by aortic cannula stream jets. Our aim was to evaluate symptoms of cerebrovascular accident and side differences from a retrospective statistical analysis.

METHODS: During a 2-year period, 2641 consecutive cardiac surgery cases were analyzed. Patients positive for cerebrovascular accident were extracted from a database designed to monitor clinical symptoms. A protocol was used to confirm symptom data with the correct diagnosis in patient records. Patients were subdivided into 3 groups: control, immediate cerebrovascular accident, and delayed cerebrovascular accident.

RESULTS: Among pooled patients, immediate and delayed cerebrovascular accidents were 3.0% and 0.9%, respectively. The expected predisposing factors behind immediate cerebrovascular accidents were significant, although the type of operation affected this search. Aortic quality was a strong predictor (P < .001). The rate of delayed cerebrovascular accident was unaffected by surgery group. Left-sided symptoms of immediate cerebrovascular accident were approximately twice as frequent (P = .016) as on the contralateral side. This phenomenon was observed for pooled patients and for isolated coronary bypass procedures (n = 1882; P = .025).

CONCLUSIONS: Immediate cerebrovascular accident and aortic calcifications are linked. The predominance of left-sided symptoms may suggest that aortic manipulation and anatomic mechanisms in the aortic arch are more likely to cause cerebrovascular accidents than effects from cannula stream jets.

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				P. Boivie, M. Hansson, and K. G. Engstrom Intraluminal aortic manipulation by means of intra-aortic filter, cannulation, and external clamp maneuvers evaluated versus dislodged embolic material J. Thorac. Cardiovasc. Surg., February 1, 2006; 131(2): 283 - 289. [Abstract] [Full Text] [PDF]