STS Works to Reduce Stroke Incidence after Cardiac Surgery

STS News, Summer 2013 -- Society leadership is embarking on a new initiative to address the occurrence of stroke following coronary artery bypass grafting (CABG) surgery and aortic valve replacement (AVR).

“Although the risk of stroke is very low after cardiac surgery, it remains a devastating complication that has a major impact on quality of life for those rare patients. STS and cardiothoracic surgeons have identified stroke as a real opportunity to improve outcomes and quality of life for our patients,” said STS President Douglas E. Wood, MD.

According to a meta-analysis published in the Journal of the American College of Cardiology in August 2012, the 30-day stroke rate was 1.2% following CABG compared with 0.34% after percutaneous coronary intervention.

To tackle this problem, STS surgeon leaders formed the Task Force on Neurologic Events Following CABG and AVR to analyze the available data and come up with suggestions on what steps cardiothoracic surgeons can take to reduce the incidence of stroke in their practices.

“The ultimate objective of the task force is to come up with a series of recommendations for how programs can change their treatment algorithms to limit stroke,” said John S. Ikonomidis, MD, PhD, Task Force Chair and Chair of the Workforce on Adult Cardiac and Vascular Surgery. “The idea is that we would like to try and get our stroke rates down to or below the levels seen in patients that undergo percutaneous intervention.”

The Task Force will now carefully analyze the years of data stored in the STS National Database to come up with a comprehensive risk prediction model for stroke following CABG and AVR. Once the model has been created, the Task Force will use it to identify opportunities across the board for improvements.

The Task Force will also scrutinize those programs in the Database that have high and low stroke rates in order to understand the differences between them. Task Force members will also take a close look at the newest technologies and techniques to identify those that have been most efficacious in reducing stroke.

“We don’t have a good handle on all the risk factors, and we don’t really understand the mechanisms of what causes stroke after coronary bypass, so our efforts will include these areas as well,” Dr. Ikonomidis said.

While there isn’t a target date for completion of this project, Dr. Ikonomidis said the STS leadership considers it to be a high-priority issue, so things should move forward quickly. Read more about the importance of this new STS initiative in the July issue of The Annals of Thoracic Surgery, which features an editorial on the topic from Drs. Wood and Ikonomidis.