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.