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Ann Thorac Surg 1999;68:1465
© 1999 The Society of Thoracic Surgeons

Supplement: Outcomes ’99: Scientific Abstracts

Low hemoglobin during cardiopulmonary bypass is associated with stroke in elderly patients

C.E. Baisden, MDa, A. Hillis, PhDa, H. Rajab, PhDa, C.G. Reiter, MDa, W.L. Knight, MDa

a Scott and White Clinic, Texas A&M University Health Science Center College of Medicine, Temple, Texas, USA

Background: Hemodilution during cardiopulmonary bypass (CPB) sometimes results in transient low hemoglobin level. We became concerned that our elderly heart surgery patients may be at increased risk for stroke if the hemoglobin got too low while they were on pump. To test the hypothesis that low intraoperative hemoglobin levels may be a risk factor for intraoperative stroke in cardiac surgery patients >= 70 years old we reviewed and analyzed our patient data.

Methods: The records of 348 consecutive patients age 70 years or more, who had heart surgery at our institution between December 1992 and May 1995, were reviewed. All patients except one had hemoglobin levels determined during CPB recorded in the chart. Intraoperative strokes were defined as those patients who had a new neurologic deficit after CPB. The relationship of stroke to hemoglobin level was investigated in 347 patients using the method of Mantel and Haenszel.

Results: Nine (2.6%) of the 348 elderly patients suffered an intraoperative stroke. The strokes were significantly congregated in patients with low hemoglobin. Lowest intraoperative hemoglobin to intraoperative stroke was >=7 g = 1.7% (4 out of 229); >= 6 to <7 g = 2.3% (2 out of 87); 5.5 to <6 g = 4.3% (1 out of 23); and <5.5 g = 25% (2 out of 8); p for linear trend = 0.004.

Conclusions: Our data does not show a cause, but an association between low hemoglobin and stroke in patients 70 years and older. Further study of this association seems warranted.





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