Ann Thorac Surg 1999;68:398
© 1999 The Society of Thoracic Surgeons
Invited Commentaries
Richard M. Engelman, MDa
a Division of Cardiac Surgery Baystate Medical Center 759 Chestnut St Springfield, MA 01107, USA
Invited commentary
This report is a comprehensive analysis of stroke occurring after cardiac surgical procedures in the VA Hospital System. It clearly defines factors that predispose to postoperative stroke and lists them based on preoperative, operative, and postoperative predictors. The value of the report is to alert physicians to what factors predispose to stroke that are potentially alterable. Clearly, stroke as a cardiac surgical complication remains one of the most common and devastating problems that we face.
One issue raised, for example, is the strong association between postoperative atrial fibrillation and stroke (p < 0.001). As the authors expressed in the Comment, this association might be reduced by early anticoagulation for atrial fibrillation in our postoperative population. This approach must, however, be carefully studied, as there may be complications from anticoagulation. Additionally, the significant association of hypertension and stroke may be influenced by improved blood pressure (BP) control. The authors noted that overzealous BP reduction can lead to ischemic strokes. Thus, BP management in our patient population requires sophistication and experience. Reducing the risk of stroke associated with heart surgery requires an appreciation of the many predisposing factors as described in Almassi’s report.
Related Article
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Stroke in cardiac surgical patients: determinants and outcome
- G. Hossein Almassi, Tracy Sommers, Thomas E. Moritz, A. Laurie W. Shroyer, Martin J. London, William G. Henderson, Gulshan K. Sethi, Frederick L. Grover, and Karl E. Hammermeister
Ann. Thorac. Surg. 1999 68: 391-397.
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