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• Objective
• Methods
• Results
• Conclusion

Objective

To analyze the occurrence of postoperative neurological complications, defined as cerebrovascular accident (CVA) and transient ischemic attack (TIA), after myocardial revascularisation, in relation to pre- and perioperative variables.

Methods

We analyzed the pre-, peri-, and postoperative data of 3834 patients who underwent primary isolated bypass grafting between January 1987 and December 1995. Unifactor risk analysis was used to identify which of the variables was a risk factor for neurological complications. Which of these variables contribute independently was analysed using multifactor risk regression analysis. A χ² test was used to identify which independent predictor changed with time. The studied period of 9 years was divided into three time cohorts of 3 years each.

Results

The incidence of neurological complications was 32/3834 patients (0.8%), and increased from 0.6% over 0.8% to 1.1% during studied period. Unifactor analysis identified the following as risk factors: age > 75 years(P = 0.008), peripheral vascular atherosclerosis or operation (carotid; P = 0.002), preoperative neurological pathology (P = 0.003), perioperative detected aortapathology (P < 0.0001) and perioperative myocardial infarction (P = 0.01). Multifactor risk regression analysis identified preoperative neurological pathology (P = 0.02), perioperative detected aortic pathology (P = 0.0001), and a perioperative myocardial infarction (P = 0.04) as independent predictors for postoperative neurological complications. In the three time cohorts there was a statistically significant change of prevalence for preoperative neurological pathology (P = 0.02) and perioperatively detected aortic pathology (P = 0.001).

Conclusion

Preoperative neurological pathology, perioperative myocardial infarction, but primarily aortapathology were identified as independent risk factors for postoperative CVA and/or TIA after myocardial revascularization. On the basis of these results the use of transoesophageal echocardiography for detection of aorta pathology in risk patients and single aorta cross-clamping should be strongly advised.

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