Silent brain infarction after minimally invasive cardiac surgery with retrograde perfusion

Benefit of minimally invasive extracorporeal circulation on minimally invasive aortic valve replacement through right lateral mini-thoracotomy using femoral cannulation: a propensity-matched analysis

OBJECTIVES

The objective of this study was to evaluate the impact of minimally invasive extracorporeal circulation on blood transfusion and asymptomatic brain injury in comparison to conventional extracorporeal circulation in the context of minimally invasive aortic valve replacement through right lateral mini-thoracotomy surgery.

METHODS

This was a retrospective observational study. Patients who underwent isolated aortic valve replacement through right lateral mini-thoracotomy surgery were divided into two groups: the minimally invasive extracorporeal circulation group and the conventional extracorporeal circulation group. Propensity matching was employed for further analysis.

RESULTS

Of 242 patients, the minimally invasive group and conventional group comprised 166 patients and 76 patients, respectively. In the matched cohort of 71 pairs, the two groups had similar preoperative characteristics. Extracorporeal circulation time was similar between the minimally invasive and conventional groups: 113 and 115 min, respectively, as was aortic clamp time: 86 and 82 min, respectively. Estimated amount of haemodilution was lower in the minimally invasive group (16.8 vs. 18.8%, P = 0.006). Blood transfusion frequency during surgery was less than half of conventional in the minimally invasive group (12.7 vs. 31.0%, P = 0.01). There were no deaths or stroke in either group during the hospital stay. Asymptomatic brain injury rate was the same for the two groups (35.2 vs. 35.2%, P = 1.00).

CONCLUSIONS

Minimally invasive extracorporeal circulation was associated with fewer patients requiring transfusion than conventional extracorporeal circulation without an increase of asymptomatic brain injury in minimally invasive aortic valve replacement through right lateral mini-thoracotomy surgery.

Analysis and prevention strategies of risk factors for postoperative stroke complications in cardiac surgery

OBJECTIVE

To analyze the risk factors associated with postoperative stroke complications in cardiac surgery.

METHODS

A retrospective analysis was conducted on the clinical data of 549 patients who underwent cardiac surgery. Among these patients, 501 did not experience a stroke postoperatively (non-stroke group), while 48 developed a postoperative stroke (stroke group). Patients who experienced a stroke postoperatively were divided into two groups based on the type of surgery: those who underwent surgery with cardiopulmonary bypass (18 patients) and those without cardiopulmonary bypass (30 patients). The clinical characteristics of the two groups of patients with postoperative strokes were compared, and the risk factors influencing the occurrence of postoperative stroke complications in cardiac surgery were analyzed.

RESULTS

① Clinical findings: Cardiopulmonary bypass group had lower cortical infarction rates but higher large-area and bilateral infarction rates compared to the non-cardiopulmonary bypass group (p < 0.05). No significant gender, age, or infarction type differences were observed (p > 0.05). ② Univariate analysis: No significant differences were found in gender, smoking, alcohol, lipids, or glucose levels (p > 0.05). However, age, education, hypertension, diabetes, hypotension, and atrial fibrillation showed significant differences (p < 0.05). ③ Multivariate Logistic regression: Age, education, hypertension, diabetes, hypotension, and atrial fibrillation were independent risk factors for postoperative stroke complications (p < 0.05).

CONCLUSION

Cardiopulmonary bypass increases risk of large-area and bilateral strokes; non-bypass surgery associates with cortical strokes. Age, educational level, hypertension, diabetes, postoperative hypotension, and atrial fibrillation are all factors independently associated with the occurrence of postoperative cerebral infarctions in cardiac surgery. Early interventions may reduce postoperative strokes.