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The Annals of Thoracic Surgery, Vol 40, 574-581, Copyright © 1985 by The Society of Thoracic Surgeons
TJ Gardner, PJ Horneffer, TA Manolio, TA Pearson, VL Gott, WA Baumgartner, AM Borkon, L Watkins Jr and BA Reitz
To identify possible risk factors for the occurrence of stroke during
coronary artery bypass grafting (CABG), the cases of 3,279 consecutive
patients having isolated CABG from 1974 to 1983 were reviewed. During this
period, the risk of death fell from 3.9% to 2.6%. The stroke rate, however,
fell initially but then rose from 0.57% in 1979 to 2.4% in 1983. Adjustment
of these data for age clearly demonstrated that the risk of stroke has
increased largely because of an increase in the mean age of patients
undergoing CABG procedures. A case-control study involving all 56 stroke
victims and 112 control patients was used to identify those risk factors
significantly associated with the development of stroke in univariate
analysis: increased age (63 versus 57 years in stroke patients and
controls, respectively; p less than 0.0001); preexisting cerebrovascular
disease (20% versus 8%; p less than 0.03); severe atherosclerosis of the
ascending aorta (14% versus 3%; p less than 0.005); protracted
cardiopulmonary bypass time (122 minutes versus 105 minutes; p less than
0.005); and severe perioperative hypotension (23% versus 4%; p less than
0.0001). Other variables not found to correlate with postoperative stroke
included previous myocardial infarction, hypertension, diabetes mellitus,
lower extremity vascular disease, preoperative left ventricular function,
and intraoperative perfusion techniques. Elderly patients who have
preexisting cerebrovascular disease or severe atherosclerosis of the
ascending aorta or who require extensive revascularization procedures have
a significantly increased risk of postoperative stroke.
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C. W. Hogue Jr, S. F. Murphy, K. B. Schechtman, and V. G. Davila-Roman Risk Factors for Early or Delayed Stroke After Cardiac Surgery Circulation, August 10, 1999; 100(6): 642 - 647. [Abstract] [Full Text] [PDF]
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G. H. Almassi, T. Sommers, T. E. Moritz, A. L. W. Shroyer, M. J. London, W. G. Henderson, G. K. Sethi, F. L. Grover, and K. E. Hammermeister Stroke in cardiac surgical patients: determinants and outcome Ann. Thorac. Surg., August 1, 1999; 68(2): 391 - 397. [Abstract] [Full Text] [PDF]
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R. L. Wolman, N. A. Nussmeier, A. Aggarwal, M. S. Kanchuger, G. W. Roach, M. F. Newman, C. M. Mangano, K. E. Marschall, C. Ley, D. M. Boisvert, et al. Cerebral Injury After Cardiac Surgery : Identification of a Group at Extraordinary Risk Stroke, March 1, 1999; 30(3): 514 - 522. [Abstract] [Full Text] [PDF]
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C. J. Mullany, M. B. Mock, M. M. Brooks, S. F. Kelsey, N. M. Keller, K. Sutton-Tyrrell, K. M. Detre, and R. L. Frye Effect of age in the bypass angioplasty revascularization investigation (BARI) randomized trial Ann. Thorac. Surg., February 1, 1999; 67(2): 396 - 403. [Abstract] [Full Text] [PDF]
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S. Ashraf, K. Bhattacharya, S. Zacharias, P. Kaul, P. H. Kay, and K. G. Watterson Serum S100{beta} release after coronary artery bypass grafting: roller versus centrifugal pump Ann. Thorac. Surg., December 1, 1998; 66(6): 1958 - 1962. [Abstract] [Full Text] [PDF]
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C. T. Wass, J. R. Waggoner III, D. G. Cable, H. V. Schaff, D. R. Schroeder, and W. L. Lanier Selective convective brain cooling during hypothermic cardiopulmonary bypass in dogs Ann. Thorac. Surg., December 1, 1998; 66(6): 2008 - 2014. [Abstract] [Full Text] [PDF]
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R. C. King, R. C. Kanithanon, K. S. Shockey, W. D. Spotnitz, C. G. Tribble, and I. L. Kron Replacing the atherosclerotic ascending aorta is a high-risk procedure Ann. Thorac. Surg., August 1, 1998; 66(2): 396 - 401. [Abstract] [Full Text] [PDF]
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W. Plochl, D. J. Cook, T. A. Orszulak, and R. C. Daly Critical cerebral perfusion pressure during tepid heart operations in dogs Ann. Thorac. Surg., July 1, 1998; 66(1): 118 - 123. [Abstract] [Full Text] [PDF]
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H. Jonsson, P. Johnsson, C. Alling, S. Westaby, and S. Blomquist Significance of Serum S100 Release After Coronary Artery Bypass Grafting Ann. Thorac. Surg., June 1, 1998; 65(6): 1639 - 1644. [Abstract] [Full Text] [PDF]
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C. T. Wass, J. W. III, D. G. Cable, H. V. Schaff, D. R. Schroeder, and W. L. Lanier Selective convective brain cooling during normothermic cardiopulmonary bypass in dogs J. Thorac. Cardiovasc. Surg., June 1, 1998; 115(6): 1350 - 1357. [Abstract] [Full Text] [PDF]
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DavidP. Bichell, J. M. Balaguer, S. F. Aranki, G. S. Couper, D. H. Adams, R. J. Rizzo, J. J. Collins Jr, and L. H. Cohn Axilloaxillary Cardiopulmonary Bypass: A Practical Alternative to Femorofemoral Bypass Ann. Thorac. Surg., September 1, 1997; 64(3): 702 - 705. [Abstract] [Full Text]
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D. Barbut, Y.-W. Lo, G. S. Hartman, F.-S. F. Yao, R. R. Trifiletti, D. N. Hager, R. B. Hinton, J. P. Gold, and O. W. Isom Aortic Atheroma Is Related to Outcome but Not Numbers of Emboli During Coronary Bypass Ann. Thorac. Surg., August 1, 1997; 64(2): 454 - 459. [Abstract] [Full Text]
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M. A. Sloan, T. R. Price, M. L. Terrin, S. Forman, J. M. Gore, B. R. Chaitman, M. Hodges, H. Mueller, W. J. Rogers, G. L. Knatterud, et al. Ischemic Cerebral Infarction After rt-PA and Heparin Therapy for Acute Myocardial Infarction : The TIMI-II Pilot and Randomized Clinical Trial Combined Experience Stroke, June 1, 1997; 28(6): 1107 - 1114. [Abstract] [Full Text]
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 N. T. Kouchoukos, B. Barzilai, V. G. Davila-Roman, M. D. Hariawala, M. A. Goldsborough, O. A. Selnes, G. M. McKhann, G. W. Roach, and D. T. Mangano Adverse Cerebral Outcomes after Coronary Bypass Surgery N. Engl. J. Med., May 29, 1997; 336(22): 1605 - 1607. [Full Text]
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D. Barbut, Y.-W. Lo, J. P. Gold, R. R. Trifiletti, F. S. Frank Yao, D. N. Hager, R. B. Hinton, and O. W. Isom Impact of Embolization During Coronary Artery Bypass Grafting on Outcome and Length of Stay Ann. Thorac. Surg., April 1, 1997; 63(4): 998 - 1002. [Abstract] [Full Text]
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L. Shore-Lesserson and S. N. Konstadt Aortic Atherosclerosis: Should We Bother to Look for It? Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 1997; 1(1): 39 - 48. [PDF]
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 G. L. Hines, W. C. Scott, S. L. Schubach, D. Tyd, and U. Wehbe Hemodynamically Significant Carotid Disease and Prophylactic Carotid Endarterectomy in CABG Patients Impact on Perioperative Neurologic Events Vascular and Endovascular Surgery, March 1, 1997; 31(2): 147 - 151. [Abstract] [PDF]
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G. M. McKhann, M. A. Goldsborough, L. M. Borowicz Jr, E. D. Mellits, R. Brookmeyer, S. A. Quaskey, W. A. Baumgartner, D. E. Cameron, R. S. Stuart, and T. J. Gardner Predictors of Stroke Risk in Coronary Artery Bypass Patients Ann. Thorac. Surg., February 1, 1997; 63(2): 516 - 521. [Abstract] [Full Text]
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G. W. Roach, M. Kanchuger, C. M. Mangano, M. Newman, N. Nussmeier, R. Wolman, A. Aggarwal, K. Marschall, S. H. Graham, C. Ley, et al. Adverse Cerebral Outcomes after Coronary Bypass Surgery N. Engl. J. Med., December 19, 1996; 335(25): 1857 - 1864. [Abstract] [Full Text] [PDF]
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L. L. Mickleborough, P. M. Walker, Y. Takagi, M. Ohashi, J. Ivanov, and M. Tamariz RISK FACTORS FOR STROKE IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING J. Thorac. Cardiovasc. Surg., November 1, 1996; 112(5): 1250 - 1259. [Abstract] [Full Text]
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C. T. Mora, M. B. Henson, W. S. Weintraub, J. M. Murkin, T. D. Martin, J. M. Craver, J. P. Gott, and R. A. Guyton THE EFFECT OF TEMPERATURE MANAGEMENT DURING CARDIOPULMONARY BYPASS ON NEUROLOGIC AND NEUROPSYCHOLOGIC OUTCOMES IN PATIENTS UNDERGOING CORONARY REVASCULARIZATION J. Thorac. Cardiovasc. Surg., August 1, 1996; 112(2): 514 - 522. [Abstract] [Full Text]
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The French Study of Aortic Plaques in Stroke Group Atherosclerotic Disease of the Aortic Arch as a Risk Factor for Recurrent Ischemic Stroke N. Engl. J. Med., May 9, 1996; 334(19): 1216 - 1221. [Abstract] [Full Text] [PDF]
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E. P. Mahanna, J. A. Blumenthal, W. D. White, N. D. Croughwell, C. P. Clancy, L. R. Smith, and M. F. Newman Defining Neuropsychological Dysfunction After Coronary Artery Bypass Grafting Ann. Thorac. Surg., May 1, 1996; 61(5): 1342 - 1347. [Abstract] [Full Text]
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C. Legault, C. D. Furberg, L. E. Wagenknecht, A. T. Rogers, D. A. Stump, L. Coker, B. T. Troost, and J. W. Hammon Nimodipine Neuroprotection in Cardiac Valve Replacement : Report of an Early Terminated Trial Stroke, April 1, 1996; 27(4): 593 - 598. [Abstract] [Full Text]
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J. M. Redmond, P. S. Greene, M. A. Goldsborough, D. E. Cameron, R. S. Stuart, M. S. Sussman, L. Watkins Jr, J. C. Laschinger, G. M. McKhann, M. V. Johnston, et al. Neurologic Injury in Cardiac Surgical Patients With a History of Stroke Ann. Thorac. Surg., January 1, 1996; 61(1): 42 - 47. [Abstract] [Full Text]
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E. J. Heyer, E. Delphin, D. C. Adams, E. A. Rose, C. R. Smith, G. J. Todd, M. Ginsburg, R. Haggerty, and D. J. McMahon Cerebral Dysfunction After Cardiac Operations in Elderly Patients Ann. Thorac. Surg., December 1, 1995; 60(6): 1716 - 1722. [Abstract] [Full Text]
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 P. Hornick and K M Taylor A Difficult Case: Perform carotid endarterectomy and coronary artery bypass surgery as a single procedure BMJ, June 3, 1995; 310(6992): 1451 - 1452. [Full Text]
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R. C Groom, A. G Hill, B. Kuban, W. Oneill, B. F Akl, A. M Speir, J. Koningsberg, G. T Sprissler, M. Shakoor, P. S Massimiano, et al. Aortic cannula velocimetry Perfusion, May 1, 1995; 10(3): 183 - 188. [PDF]
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A. J. Baker, B. Naser, M. Benaroia, and C. D. Mazer Cerebral Microemboli During Coronary Artery Bypass Using Different Cardioplegia Techniques Ann. Thorac. Surg., May 1, 1995; 59(5): 1187 - 1191. [Abstract] [Full Text]
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S. A. Mills Risk Factors for Cerebral Injury and Cardiac Surgery Ann. Thorac. Surg., May 1, 1995; 59(5): 1296 - 1299. [Abstract] [Full Text]
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M. F. Newman, N. D. Croughwell, J. A. Blumenthal, E. Lowry, W. D. White, W. Spillane, R. D. Davis Jr, D. D. Glower, L. R. Smith, E. P. Mahanna, et al. Predictors of Cognitive Decline After Cardiac Operation Ann. Thorac. Surg., May 1, 1995; 59(5): 1326 - 1330. [Abstract] [Full Text]
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J. A. Blumenthal, E. P. Mahanna, D. J. Madden, W. D. White, N. D. Croughwell, and M. F. Newman Methodological Issues in the Assessment of Neuropsychologic Function After Cardiac Surgery Ann. Thorac. Surg., May 1, 1995; 59(5): 1345 - 1350. [Abstract] [Full Text]
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