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AHA Details How to Lower Stroke Risk During, After Heart Surgery

WEDNESDAY, Aug. 26, 2020 -- In a scientific statement issued by the American Heart Association and published online Aug. 26 in Circulation, recommendations are presented for reducing the risk for perioperative stroke in adults undergoing cardiac and thoracic aortic operations.

Mario Gaudino, M.D., from Weill Cornell Medicine in New York City, and colleagues provide suggestions on preoperative, intraoperative, and postoperative strategies aimed at reducing the risk for perioperative stroke among patients undergoing cardiac surgery.

The researchers note that intraoperative neuromonitoring based on local availability and expertise is suggested for stroke prevention, with use of epiaortic scanning recommended. A mean arterial pressure of 60 to 65 mm Hg should be maintained during cardiopulmonary bypass. For aortic cases with expected long circulatory arrest time, active perfusion techniques should be used. In the presence of intracardiac thrombus, surgical thrombectomy or delay of surgery and anticoagulation should be considered. A complete postoperative neurologic exam should be performed as soon as the clinical situation allows. A fast-track anesthesia protocol should be considered for those at high risk for stroke. A "stroke team" should be in place, and in the case of clinical suspicion of stroke, they should be alerted immediately. In the case of perioperative stroke, the patient should be transferred to the intensive care setting; cerebral oxygenation and perfusion should be optimized; and thrombolysis and thrombectomy should be considered.

"It's imperative that a stroke team work together to assess a patient's health before, during, and after heart surgery," Gaudino said in a statement.

Several members of the writing committee and one reviewer disclosed financial ties to the pharmaceutical and medical device industries.

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