Fausto Biancari1, Tuomas Tauriainen2, Andrea Perrotti3, Magnus Dalén4, Giuseppe Faggian5, Ilaria Franzese5, Sidney Chocron3, Vito G Ruggieri6, Karl Bounader6, Helmut Gulbins7, Daniel Reichart7, Peter Svenarud4, Giuseppe Santarpino8, Theodor Fischlein8, Tamas Puski8, Daniele Maselli9, Carmelo Dominici9, Saverio Nardella9, Giovanni Mariscalco10, Riccardo Gherli11, Francesco Musumeci11, Antonino S Rubino12, Carmelo Mignosa12, Marisa De Feo13, Ciro Bancone13, Giuseppe Gatti14, Luca Maschietto14, Francesco Santini15, Antonio Salsano15, Francesco Nicolini16, Tiziano Gherli16, Marco Zanobini17, Matteo Saccocci17, Paola D'Errigo18, Eeva-Maija Kinnunen2, Francesco Onorati5. 1. Department of Surgery, Oulu University Hospital, Oulu, Finland. Electronic address: faustobiancari@yahoo.it. 2. Department of Surgery, Oulu University Hospital, Oulu, Finland. 3. Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France. 4. Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 5. Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy. 6. Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France. 7. Hamburg University Heart Center, Hamburg, Germany. 8. Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany. 9. Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy. 10. Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester, UK. 11. Unit of Cardiac Surgery, Department of Cardiosciences, Hospital S. Camillo-Forlanini, Rome, Italy. 12. Centro Cuore Morgagni, Pedara, Italy. 13. Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy. 14. Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy. 15. Division of Cardiac Surgery, University of Genoa, Genoa, Italy. 16. Division of Cardiac Surgery, University of Parma, Parma, Italy. 17. Department of Cardiac Surgery, Centro Cardiologico-Fondazione Monzino IRCCS, University of Milan, Italy. 18. National Institute for Health, Rome, Italy.
Abstract
INTRODUCTION: This study was planned to investigate the impact of severe bleeding and blood transfusion on the development of stroke after coronary surgery. METHODS: This cohort study includes 2357 patients undergoing isolated CABG from the prospective European Coronary Artery Bypass Grafting (E-CABG) registry. Severity of bleeding was categorized according to the Universal Definition of Perioperative Bleeding (UDPB), E-CABG and PLATO definitions. RESULTS: Thirty patients (1.3%) suffered postoperative stroke. The amount of transfused red blood cell (RBC) (OR 1.10, 95%CI 1.03-1.18), preoperative use of unfractioned heparin (OR 4.49, 95%CI 1.91-10.60), emergency operation (OR 3.97, 95%CI 1.47-10.74), diseased ascending aorta (OR 4.62, 95%CI 1.37-15.65) and use of cardiopulmonary bypass (p = 0.043, OR 4.85, 95%CI 1.05-22.36) were independent predictors of postoperative stroke. Adjusted analysis showed that UDPB classes 3-4 (crude rate: 3.6% vs. 1.0%; adjusted OR 2.66, 95%CI 1.05-6.73), E-CABG bleeding grades 2-3 (crudes rate: 6.3% vs. 0.9%; adjusted OR 5.91, 95%CI 2.43-14.36), and PLATO life-threatening bleeding (crude rate: 2.5% vs. 0.6%, adjusted OR 3.70, 95%CI 1.59-8.64) were associated with an increased risk of stroke compared with no or moderate bleeding. CONCLUSIONS: Bleeding and blood transfusion are associated with an increased risk of stroke after CABG, which is highest in patients with severe bleeding.
INTRODUCTION: This study was planned to investigate the impact of severe bleeding and blood transfusion on the development of stroke after coronary surgery. METHODS: This cohort study includes 2357 patients undergoing isolated CABG from the prospective European Coronary Artery Bypass Grafting (E-CABG) registry. Severity of bleeding was categorized according to the Universal Definition of Perioperative Bleeding (UDPB), E-CABG and PLATO definitions. RESULTS: Thirty patients (1.3%) suffered postoperative stroke. The amount of transfused red blood cell (RBC) (OR 1.10, 95%CI 1.03-1.18), preoperative use of unfractioned heparin (OR 4.49, 95%CI 1.91-10.60), emergency operation (OR 3.97, 95%CI 1.47-10.74), diseased ascending aorta (OR 4.62, 95%CI 1.37-15.65) and use of cardiopulmonary bypass (p = 0.043, OR 4.85, 95%CI 1.05-22.36) were independent predictors of postoperative stroke. Adjusted analysis showed that UDPB classes 3-4 (crude rate: 3.6% vs. 1.0%; adjusted OR 2.66, 95%CI 1.05-6.73), E-CABG bleeding grades 2-3 (crudes rate: 6.3% vs. 0.9%; adjusted OR 5.91, 95%CI 2.43-14.36), and PLATO life-threatening bleeding (crude rate: 2.5% vs. 0.6%, adjusted OR 3.70, 95%CI 1.59-8.64) were associated with an increased risk of stroke compared with no or moderate bleeding. CONCLUSIONS:Bleeding and blood transfusion are associated with an increased risk of stroke after CABG, which is highest in patients with severe bleeding.
Authors: Jörn A Karhausen; Alan M Smeltz; Igor Akushevich; Mary Cooter; Mihai V Podgoreanu; Mark Stafford-Smith; Susan M Martinelli; Manuel L Fontes; Miklos D Kertai Journal: Anesth Analg Date: 2017-10 Impact factor: 5.108
Authors: Gregory A Nuttall; Mark M Smith; Bradford B Smith; Jon M Christensen; Paula J Santrach; Hartzell V Schaff Journal: Ann Thorac Cardiovasc Surg Date: 2021-12-22 Impact factor: 1.889