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OBJECTIVE:
Compare to median sternotomy, one of the biggest drawbacks of minimally invasive cardiac surgery (MICS) is higher incidence of stroke. Recent study reported the adjusted odds ratio for permanent stroke was 1.96 for MICS compared with conventional sternotomy. However, to our knowledge, new stroke evaluation with preoperative and postoperative magnetic resonance diffusion-weighted imaging (DWI) has never been explored.
METHODS:
This observational study enrolled 51consecutive patients undergoing cardiac surgery between October 2010 and July 2011. Twenty six sternotomy patients were compared to twenty five MICS patient. Conventional ascending aortic cannulation with conventional cross clamping was conducted for sternotomy group, and right femoral artery cannulation with transthoracic cross clamping direct root cannulation was performed in MICS patients. Preoperative magnetic resonance imaging with angiography and postoperative DWI with susceptibility-weighted magnetic resonance imaging (SWI) were performed. Perioperative clinical data associated with stroke were also collected.
RESULTS:
There was no clinically symptomatic stroke in both groups. Subclinical infarction was identified in twelve (23.5%) with small new focal high signal intensity on MR-DWI and microbleeds was detectable in forty (78.4%) patients with SWI. In terms of acute subclinical infarction and microbleeds, there was no difference between sternotomy(DWI;23.1%, SWI;73.1%) and MICS (DWI 24.0%, SWI; 84%) approach. (P>0.05)
CONCLUSIONS:
In this study, the prevalence of subclinical stroke on cerebral magnetic resonance imaging was comparable in both sternotomy and MICS patients. To confirm this notion, further work needs to be in a larger patient population.