Early Cardiac Surgery Under Cardiopulmonary Bypass In Patients With Cardioembolic Ischemic Stroke

Objective: To assess the feasibility of early cardiopulmonary bypass surgery in non-coma patients with cardioembolic ischemic stroke.Methods: 68 non-coma patients with cardioembolic ischemic stroke undergoing heart surgery under cardiopulmonary bypass were divided into two groups in the Military General Hospital of Beijing PLA from January 2000 to December 2015. The group A had 28 patients undergoing cardiac surgery within one month after the last occurrence of ischemic stroke. There were 15 cases of rheumatic mitral stenosis complicated with chronic atrial fibrillation, 7 cases of vegetations from infective endocarditis, 4 cases of left ventricular aneurysm with intracardiac thrombi and 2 cases of left atrial myxoma. The group B had 40 patients undergoing cardiac surgery more than one month after the last occurrence of ischemic stroke. There were 20 cases of rheumatic mitral stenosis, 13 cases of vegetations from infective endocarditis, 5 cases of left ventricular aneurysm and 2 cases of left atrial myxoma. Cardiopulmonary bypass time, aortic cross clamping time, postoperative neurologic status, postoperative delayed recovery, postoperative delayed extubation, reoperation for bleeding, time of postoperative hospitalization, costs of hospitalization and rate of mortality was compared and analysed between the two groups.Results: Cardiopulmonary bypass time(116±47min VS 109±44min, P > 0.05),aortic cross clamping time(68±35min VS 65±34min, P>0.05), postoperative delayed recovery rates(10.7% VS 7.5%, P>0.05),postoperative delayed extubation rates(14.3% VS 5.0%, P>0.05),reoperation for bleeding rates(3.6% VS 2.5%, P>0.05),time of postoperative hospitalization(49±36 h VS 42±22 h, P>0.05) and rates of mortality(0% VS 0%, P>0.05) were similar in the two groups. There were no significant differences between the two groups in neurologic deterioration rates(deterioration of brain edema, hemorrhagic transformation of the infarct and mortality)((0% VS 0%, P >0.05).Furthermore,Costs of hospitalization(12,5186±4,7968 Yuan VS 11,9364±4,8807 Yuan, P>0.05) and mortality((0% VS 0%, P>0.05) were similar in the two groups.Conclusions: This study indicates that early open heart surgery can be performed in non-coma patients with recent ischemic stroke.