ORIGINAL ARTICLE   

Chirurgia 2018 October;31(5):186-90

DOI: 10.23736/S0394-9508.18.04780-0

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Risk of embolic complication with open heart surgery

Ihab M. MOURSI ✉, Karim M. AL FAKHARANY

Department of Cardiothoracic Surgery, Zagazig University Hospital, Zagazig, Egypt

BACKGROUND: Mortality in cardiac surgery has dropped since last two decades, although patients benefiting from such surgery are increasingly fragile. Nevertheless, the rate of postoperative morbidity did not decrease. The embolic nature of the aortic manipulations, in particular during clamping and unclamping is well known, the relationship between the type of intervention and embolic complications is unclear. The aim of our study was to identify risk of embolic complication with open heart surgery.
METHODS: This is a prospective single-center study from September 2012 to September 2016 including all patients who were subjected to open cardiac surgery. We divided our population into 4 groups, according to the type of intervention: “valvular,” “coronary bypass,” “valvular with coronary bypass,” and “ascending aorta.” The primary endpoint was the occurrence of a neurological or digestive embolic complication intraoperative: stroke, TIA, confusion, mesenteric ischemia, cholecystitis, and pancreatitis.
RESULTS: 278 patients were included. 18 patients (6.5%) developed an embolic complication. The “valvular with bypass” group presents the highest complication rate (10%). In univariate analysis, there is no significant difference according to the type of aortic clamping (single, partial or multiple aortic clamping, P=0.16) and the “combined procedures” variable is associated with a higher embolic complication rate (7.6%).
CONCLUSIONS: Valvular replacement with myocardial revascularization appears to have a higher risk rate of embolic complication. We recommend a larger statistical study to confirm this rate of complication.

KEY WORDS: Cardiac surgical procedures - Embolism - Intraoperative complications