In-hospital stroke in patients after cardiovascular surgery

Introduction. Strokes in patients managed at the department of cardiovascular surgery hold a leading position among all in-hospital strokes in multispeciality hospitals. According to the literature, the prevalence of stroke ranges from 0.2–0.4% for percutaneous cardiac interventions to 16% after heart valve surgeries.

Objective. To reveal the stroke risk factors in patients managed at the department of cardiovascular surgery, including depending on the type of surgical intervention.

Materials and methods. The study group included 58 cases of acute cerebrovascular accidents (ACVA) in patients at the department of cardiovascular surgery, amounting to 30.5% of the total amount of in-hospital strokes recorded over 5 years (2011–2016).

Results. Ischemic stroke was prevalent in the study group (54 patients; 93.1%, р<0.001); four (6.9%) patients had transient ischemic attacks. The largest number of strokes occurred in patients who had undergone heart bypass (23 patients, 41.1%) and heart valve replacement surgeries (25 patients, 44.6%); in 12 (21.4%) patients, ACVA occurred after mitral valve replacement combined with tricuspid annuloplasty. In most cases, stroke developed within the first three days after surgical intervention (36 patients, 64.3%, р<0.05).

Conclusions. Patients who had undergone cardiovascular interventions, especially after heart bypass and heart valve replacement surgeries, require hemodynamic monitoring and thromboelastography during the first 3 days to prevent a stroke. Despite the early detection of in-hospital strokes, systemic thrombolytic therapy was contraindicated for all patients. Mechanical thrombus extraction should be treatment of choice for this category of patients.