Introduction: More than half of reported perioperative strokes following cardiac surgery are identified beyond postoperative day one. The objective of our study was to determine preoperative and intraoperative factors that are associated with stroke following cardiac surgery and to identify factors that may contribute delayed recognition of perioperative stroke. Methods: Patients undergoing coronary artery bypass surgery or isolated valve surgery from January 2, 2015 to April 28, 2017 at an academic health system were identified from the Society of Thoracic Surgeons Registry. We determined preoperative and intraoperative factors associated with perioperative stroke. Two neurologists performed retrospective chart reviews on perioperative stroke patients to determine the last seen well time and the stroke cause. Results: During the study period, 2795 patients underwent coronary artery bypass surgery or isolated valve surgery (mean age 64 ± 11 years, 71% male, 72% Caucasian, 9% history of stroke), of which 43 (1.5%) had a perioperative stroke; 31 (72%) patients had an embolic mechanism of stroke based on neuroimaging. In multivariable analysis, perioperative strokes were independently associated with increasing age (OR 1.04, 95% 1.01-1.07), history of stroke (OR 2.73, 95% CI 1.47-5.06), and history of thoracic aorta disease (OR 3.36, 95% CI 1.16-9.71). Strokes were identified after postoperative day one in 32 (74%) patients of which 26 (81%) had a preoperative last seen well time. Conclusion: Given the high frequency of preoperative last seen well time in perioperative stroke patients who are identified after postoperative day one, delayed stroke recognition may contribute to the bimodal distribution in timing of perioperative stroke. Frequent neurological monitoring within 24 hours after CABG or isolated valve surgery should be considered for all patients undergoing cardiac surgery, particularly elderly patients and those with a history of stroke or thoracic aorta disease, to improve early stroke recognition.

简介：心脏手术后报告的围手术期中风的一半以上是在术后第一天之后发现的。我们研究的目的是确定心脏手术后与卒中相关的术前和术中因素，并确定可能导致围手术期卒中延迟识别的因素。方法：从2015年1月2日至2017年4月28日在学术卫生系统接受冠状动脉搭桥手术或孤立瓣膜手术的患者来自胸外科医师协会注册处。我们确定了围手术期卒中相关的术前和术中因素。两名神经科医师对围手术期卒中患者进行了回顾性图表审查，以确定最后一次见到的康复时间和卒中原因。结果：在研究期间，有2795例患者接受了冠状动脉搭桥手术或孤立瓣膜手术（平均年龄64±11岁，男性71％，白人72％，中风病史9％），其中围手术期中风43例（1.5％） ; 31名（72％）患者具有基于神经影像学的中风栓塞机制。在多变量分析中，围手术期卒中与年龄增长（OR 1.04，95％1.01-1.07），卒中病史（OR 2.73，95％CI 1.47-5.06）和胸主动脉疾病史（OR 3.36，95％）独立相关。 CI 1.16-9.71）。术后第一天，在32例（74％）患者中发现中风，其中26例（81％）的患者术前最后一次见面时间为好。结论：鉴于在术后第一天被确定的围手术期卒中患者术前最后一次看好的时间频率很高，延迟的卒中识别可能会导致围手术期卒中的双峰分布。对于所有接受心脏手术的患者，特别是老年患者和有中风或胸主动脉疾病病史的患者，应考虑在CABG或孤立瓣膜手术后24小时内进行频繁的神经学监测，以改善中风的早期识别。