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Risk factors for stroke after heart surgery identified

DALLAS, Aug. 10 -- A new study helps identify which individuals may have the highest risk of stroke following heart surgery. Reporting in today's Circulation: Journal of the American Heart Association, researchers found that heart surgery patients who had previously had a stroke faced the highest risk. They had a 14-times higher risk of having a new stroke during or after surgery.

"Stroke is one of the most devastating complications of heart surgery," says Charles W. Hogue Jr., M.D., associate professor of anesthesiology and chief of cardio-thoracic anesthesia at Washington University and Barnes-Jewish Hospital in St. Louis, Mo.

Stroke incidence is as high as 5 percent in individuals undergoing bypass surgery, almost 9 percent in bypass patients age 75 or older and nearly 16 percent in patients with pre-existing disease involving blood flow in the brain or those undergoing heart valve surgery, according to Hogue. Bypass surgery involves rerouting blood flow around blocked blood vessels.

The purpose of the study was to help physicians better assess the risks of surgery as well as to identify ways to reduce the risk of post-operative stroke. In this study the post-operative strokes occurred in 48 of the patients, or 1.8 percent. "It must be emphasized that stroke happens in a low percentage of patients," Hogue says. "The benefits of heart surgery, for most patients, outweigh the risks. The surgery prolongs life."

The new research challenges several misconceptions that have persisted about post-surgical stroke, says Hogue. Unlike earlier studies, this one separated the 'early strokes' that occurred immediately after surgery when the patient was just waking up from the anesthesia from 'delayed strokes' that occurred later on. Sixty-five percent of the strokes occurred hours or even days after surgery in patients whose post-operative recovery had been uneventful. However, the early strokes, which occurred immediately following surgery, were
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Contact: Carole Bullock
caroleb@heart.org
214-706-1279
American Heart Association
9-Aug-1999


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