Original Research Article

Risk Factors for Early Neurological Complications after Coronary Artery Bypass Graft versus Valve Replacement Surgery: Regional Cardiac Center Study

Shahswar Arif¹, Zarina Brady¹, Georgi Bachvarov², Mariya Negreva^3*

¹Medical University of Varna, Varna, Bulgaria
²Department of Cardiovascular Surgery and Angiology, University Hospital “St. Marina” Varna, Bulgaria
³Department of Cardiology, University Hospital “St. Marina” Varna, Bulgaria

*Corresponding Author's E-mail: mnegreva@abv.bg
Tel: +359 888 478 303

Received: 15 November 2022  I  Accepted: 21 December 2022  I  Published: 26 December 2022  I  Article ID: MRJMMS22071
Copyright © 2022 Author(s) retain the copyright of this article.
This article is published under the terms of the Creative Commons Attribution License 4.0.

Abstract

Data on the early neurological injuries following coronary artery bypass graft (CABG) and valve replacement surgery are scarce and conflicting, especially those evaluating risk factors for their appearance. That gave us a predisposition to analyse and compare the early neurological complications following these two types of heart surgeries and find significant risk factors for their development. A retrospective observational study was conducted at the cardiac surgery of the University hospital “St. Marina” – Varna, Bulgaria for the period July 2019 – June 2020. 152 patients who underwent CABG operation and 100 patients with valve replacement operation were included consecutively in the study and followed during the early postoperative period (up to the 7th day after the operation) for the manifestation of the neurological complications: a psychomotor excitement, a delirium, cognitive deficit and a stroke. Patient demographic and clinical characteristics, as well as intraoperative variables were analysed as risk factors for these complications. For statistical analysis unpaired t-test was used. A p-value <0.05 was considered statistically significant. A total of 48 / 252 (19%) patients suffered postoperative neurological complications following cardiac surgery, 30 patients with CABG operation and 18 with valve replacement surgery. Although cognitive deficit (20% vs 5.6%), delirium (3% vs 0%) and psychomotor excitement (63.3% vs 61.1%) were higher in CABG cohort (versus valvular), differences were not statistically significant (p>0.05). However, post-operative stroke rate was significantly higher in valvular surgeries (13.3% vs 33.3%, p<0.05). Regarding risk factor evaluation, in the CABG cohort, older age, peripheral artery disease, diabetes mellitus,family history of stroke and atrial fibrillation were all statistically significantly linked to neurological complications. In the valvular cohort, dyslipidaemia, family history of stroke and longer operation time were all statistically significant (p<0.05) risk factors. Family history of stroke was recorded to be a statistically significant risk factor for stroke following both CABG and valve replacement surgery. All patients undergoing CABG/valve surgeries should be given adequate information on potential postoperative neurological complication risks, and postoperative care staff should be aware of the additional risk and be clinically equipped to deal with such complications effectively.

Keywords: Coronary artery bypass graft, Neurological complications, Risk factors, Stroke, Valve replacement surgery