Ann Thorac Surg 2000;69:1056
© 2000 The Society of Thoracic Surgeons
ORIGINAL ARTICLES: CARDIOVASCULAR
Invited commentary
J. Mark Redmond, MDa
a Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
e-mail: jredmond{at}csurg.jhmi.jhu.edu
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 Introduction
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The findings of Puskas and associates that age, previous transient ischemic attack, and carotid bruits are independent risk factors for postoperative stroke, confirm the findings of several other authors. The increased early and late mortality of patients sustaining strokes, along with prolongation of hospital stay, are remarkably similar at our institution where we have a 18.5% early mortality for stroke patients, with a 67% 1 year and 46% 5 year survival, and a 24.3 day mean length of stay. The strength of the paper however emanates from the large number of patients studied, and the fact that the data was accumulated prospectively.
Nonfocal neurologic deficits, including encephalopathy and cognitive decline, are not addressed in this work. Careful neurologic assessment by neurologists and trained neuropsychometricians is required to determine the incidence of such injury after cardiac operation (20% at our institution). Institutions setting up data collection systems to track postoperative neurologic injury ought to include such personnel.
Two of the three predictors of stroke in this work relate to carotid artery disease. While off-pump coronary operations are presently purported to be beneficial in reducing stroke in patients with aortic atherosclerosis, it will require outcomes research, such as this, to determine the influence of off-pump coronary artery bypass grafting in patients with extra or intracranial carotid artery disease.
Related Article
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Stroke after coronary artery operation: incidence, correlates, outcome, and cost
- John D. Puskas, A. Daniel Winston, Carolyn E. Wright, John Parker Gott, W. Morris Brown, III, Joseph M. Craver, Ellis L. Jones, Robert A. Guyton, and William S. Weintraub
Ann. Thorac. Surg. 2000 69: 1053-1056.
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