• J. Cardiothorac. Vasc. Anesth. · Aug 2020

    Increased Risk of Perioperative Ischemic Stroke in Patients Who Undergo Noncardiac Surgery with Preexisting Atrial Septal Defect or Patent Foramen Ovale.

    • Pedro A Villablanca, Alejandro Lemor, Chak-Yu So, Guson Kang, Tarun Jain, Tanush Gupta, Tomo Ando, Divyanshu Mohananey, Sagar Ranka, Dagmar F Hernandez-Suarez, Pablo Michel, Tiberio Frisoli, Dee Dee Wang, Marvin Eng, William O'Neill, and Harish Ramakrishna.
    • Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI.
    • J. Cardiothorac. Vasc. Anesth. 2020 Aug 1; 34 (8): 2060-2068.

    ObjectivesTo evaluate whether a preoperative diagnosis of atrial septal defect (ASD) or patent foramen ovale (PFO) is associated with perioperative stroke in noncardiac surgery and their outcomes.DesignRetrospective cohort analysis.SettingUnited States hospitals.ParticipantsAdults patients (≥18 years old) who underwent major noncardiac surgery from 2010 to 2015 were identified using the Healthcare Cost and Utilization Project's National Readmission Database.InterventionsPreoperative diagnosis of ASD or patent foramen ovale.Measurements And Main ResultsAmong the 19,659,161 hospitalizations for major noncardiac surgery analyzed, 12,248 (0.06%) had a preoperative diagnosis of ASD/PFO. Perioperative ischemic stroke occurred in 723 (5.9%) of patients with ASD/PFO and 373,291 (0.02%) of those without ASD/PFO (adjusted odds ratio [aOR], 16.7; 95% confidence interval [CI]: 13.9-20.0). Amongst the different types of noncardiac surgeries, obstetric, endocrine, and skin and burn surgery were associated with higher risk of stroke in patients with pre-existing ASD/PFO. Moreover, patients with ASD/PFO also had an increased in-hospital mortality (aOR, 4.6, 95% CI: 3.6-6.0), 30-day readmission (aOR, 1.2, 95% CI: 1.04-1.38), and 30-day stroke (aOR, 7.2, 95% CI: 3.1-16.6). After adjusting for atrial fibrillation, ischemic stroke remained significantly high in the ASD/PFO group (aOR: 23.7, 95%CI 19.4-28.9), as well as in-hospital mortality (aOR: 5.6, 95% CI 4.1-7.7), 30-day readmission (aOR: 1.19, 95%CI 1.0-1.4), and 30-day stroke (aOR: 9.3, 95% CI 3.7-23.6).ConclusionsAmong adult patients undergoing major noncardiac surgery, pre-existing ASD/PFO is associated with increased risk of perioperative ischemic stroke, in-hospital mortality, 30-day stroke, and 30-day readmission after surgery.Copyright © 2020 Elsevier Inc. All rights reserved.

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