According to this study, Stroke is a known problem of cardiac surgery, but there are few data related to stroke risk in the middle risk period from discharge up to one year of follow-up. Apart from left atrial appendage (LAA) closure and ablation, ischemic stroke readmission rates following cardiac procedures were consistently higher than the highest-risk noncardiac surgery. This study has published in Journal of the American Heart Association.
Dr. Mandip S. Dhamoon said, "These results suggest that cardiac procedures and postoperative management may confer additional vulnerability to patients who have concurrent vascular risk factors in the intermediate-term risk period.” Dr. Dhamoon and colleagues used data from 21 states to calculate the risk of stroke in this intermediate-term risk period following common cardiac procedures, noncardiac surgeries, and medical admissions.
They also focused on two comparisons: transcatheter (TAVR) versus surgical aortic valve replacement (SAVR) and coronary artery bypass graft (CABG) versus percutaneous coronary intervention (PCI). Moreover, ischemic stroke readmission rates after SAVR, cardiac catheterization, left ventricular assist device (LVAD) placement and TAVR were all higher than rates following admission for urinary tract infection (UTI), pneumonia, and chronic obstructive pulmonary disease (COPD).
Ischemic stroke readmission rates were highest after TAVR and lowest after LAA closure, whereas hemorrhagic stroke readmission rates were highest after LVAD placement and lowest after implantable cardioverter defibrillator (ICD) placement. Hemorrhagic stroke readmission rates following UTI and pneumonia were comparable to those following CABG, cardioversion and PCI. In direct comparisons, the risks of ischemic and hemorrhagic stroke did not differ significantly between CABG and PCI.
Whereas compared with SAVR, TAVR was associated with an 86% higher risk of ischemic stroke and a 6.17-fold increased risk of hemorrhagic stroke. Dr. Partha Thirumala from the University of Pittsburgh Medical Center, in Pennsylvania, who studies neurological events after surgical procedures, told Reuters Health by email, "Patients who undergo cardiac procedures are at increased risk of readmission from ischemic and hemorrhagic stroke.
“It’s surprising that patients with TAVR are at increased risk of perioperative stroke, both ischemic and hemorrhagic in the long term,” he said. “However, this is contrary to the results published in large clinical trials. This could be due to multiple factors, including the generalizable nature of the results, the type of patients undergoing the procedure, (and) the learning curve of physicians doing the operation.”
Researchers conclude, additional study is essential for better understanding the mechanisms of increased intermediate risk for these vulnerable patients that may allow the development of targeted interventions during this risk period. Then patients can benefit from the development of a risk index used to calculate the risk of cardiac complications following noncardiac surgery.