Safety of early cardiac surgery under cardiopulmonary bypass in patients with cardiogenic ischemic stroke

WANG Wen-jie; YAO Jian-min

doi:10.3969/j.issn.1674-4055.2016.04.30

Abstract：Objective To investigate the safety of early cardiac surgery under cardiopulmonary bypass (CPB) in patients with cardiogenic ischemic stroke.Methods The patients with non-coma cardiogenic ischemic stroke (n=26) were chosen from Jul. 2000 to Aug. 2015, and given cardiac valve replacement, ventricular aneurysmectomy or resection of cardiac myxoma under CPB within 1 m due to some early surgical indications such as malignant arrhythmia, uncontrolled heart failure by drugs, uncontrolled infection and repeated embolism. The types of primary cardiac diseases, surgical modes, surgical effects and follow-up results were recorded.Results Of 26 cases, 19 (73.1%) were male and aged from 32 to 67 (48.6±11.3). There were 14 patients with rheumatic heart disease, 7 with infective endocarditis, 3 with coronary heart disease complicating left ventricular aneurysm and 2 with left atrial myxoma. There were 14 cases undergone mitral valve replacement, 6 undergone aortic valve replacement, 1 undergone mitral valve and aortic double valve replacement, 3 undergone coronary artery bypass grafting and left ventricular aneurysmectomy and 2 undergone resection of left atrial myxoma. There were 26 cases cured and no one died. There were 3 cases with delayed analepsia, 4 with delayed extubation and 1 with second chest opening for stanching. During the follow up period from 3 m to 60 m (28.0±5.6), 1 case died of cerebral hemorrhage due to improper anticoagulation 2 m after cardiac valve replacement, and there was no one with relapse of stroke.Conclusion Cardiac surgery under CPB within 1 m is safe for patients with cardiogenic ischemic stroke complicating malignant arrhythmia, uncontrolled heart failure by drugs, uncontrolled infection and repeated embolism.