RISK FACTORS FOR PERIOPERATIVE STROKE DEVELOPMENT IN CARDIAC SURGERY

Аннотация

Risk factors for perioperative stroke development are diverse and can be divided into patient-related factors and factors directly related to surgical intervention. This review discusses risk factors, potential mechanisms, prevention strategies, and the impact of stroke on clinical outcomes in the postoperative period. Keywords: stroke, cardiac surgery, pathogenesis, cardiovascular complications. ФАКТОРЫ РИСКА РАЗВИТИЯ ПЕРИОПЕРАЦИОННОГО ИНСУЛЬТА ПРИ КАРДИОХИРУРГИЧЕСКИХ ВМЕШАТЕЛЬСТВАХ Арипов Дилшодбек Муродиллоевич https://orcid.org/ 0009-0004-1840-0819 Бухарский государственный медицинский институт имени Абу Али ибн Сино, Узбекистан, г. Бухара. Аннотация Факторы риска развития периоперационного инсульта многообразны, и они условно могут быть разделены на факторы, связанные с пациентом, и факторы, связанные непосредственно с оперативным вмешательством. Данный обзор посвящен обсуждению факторов риска, потенциальных механизмов, стратегий профилактики, а также влиянию инсульта на клинические исходы в послеоперационном периоде. Ключевые слова: инсульт, кардиохирургия, патогенез, сердечно- сосудистые осложнения. YURAK JARROHLIGIDA PERIOPERATIV INSULT RIVOJLANISHI XAVF FAKTORLARI Aripov Dilshodbek Murodilloevich https://orcid.org/ 0009-0004-1840-0819 Abu Ali ibn Sino nomidagi Buxoro davlat tibbiyot instituti, O‘zbekiston, Buxoro. Annotatsiya Perioperativ insult rivojlanishi uchun xavf omillari xilma-xil bo'lib, ularni bemor bilan bog'liq omillarga va jarrohlik aralashuvga bevosita bog'liq bo'lgan omillarga bo'lish mumkin. Ushbu sharhda xavf omillari, potentsial mexanizmlar, oldini olish strategiyalari va operatsiyadan keyingi davrda insultning klinik natijalarga ta'siri muhokama qilinadi. https://scientific-jl.com/new 11 22 55 Volume–81_Issue-1_July-2025 JOURNAL OF NEW CENTURY INNOVATIONS Kalit so'zlar: insult, kardiojarrohlik, patogenez, yurak-qon tomir asoratlari. Relevance of the research Perioperative stroke is the most severe complication of surgical interventions. The risk of developing this complication depends on the type of intervention. If in non- cardiac surgical interventions it is 0.1–2.0%, then in high-risk cardiac surgery it can reach 10% [1]. Perioperative stroke leads to an increase in mortality and disability of patients, and also contributes to the overexpenditure of financial and human resources. Clinically hidden (asymptomatic) strokes also contribute to the deterioration of neurocognitive dysfunction in the long term, as well as the development of clinically significant strokes [2]. A consensus document of the Society for the Neurosciences of Anesthesiology and Critical Care defines perioperative stroke as a cerebral infarction of ischemic or hemorrhagic etiology that occurs during surgery or 30 days after surgery, including the development of stroke after awakening from anesthesia. Perioperative Stroke Rate and Its Impact on Clinical Outcomes Despite advances in medical technology and drug development, perioperative neurological complications remain a major cause of increased hospital stay, disability, and mortality. A minority of all perioperative strokes occur intraoperatively; 30% occur within the first 2 days; approximately 50% occur by the 5th postoperative day; and 20–25% develop during hospitalization [3]. According to the American College of Surgeons database, the stroke rate in patients undergoing low-risk surgery is 0.14% [4]. In the prospective VISION study, which included 40,004 patients over 45 years of age undergoing non-cardiac surgery (28 centers from 14 countries), the stroke rate was 0.3% [5]. This study showed that ischemic stroke was much more common than hemorrhagic stroke. The prospective cohort multicenter NeuroVISION study included 1114 patients over 65 years of age who underwent elective non-cardiac surgery [6]. All patients underwent MRI in the immediate postoperative period to assess latent (clinically "silent") stroke. In addition, all patients underwent neurocognitive status and delirium assessment. It was shown that the incidence of latent stroke was 7% (78 patients). Moreover, the development of this complication was accompanied by an increased risk of postoperative delirium (by 2.2 times) and deterioration of neurocognitive function 1 year after surgery (by 2 times). The risk of transient ischemic attack within 1 year after surgery in patients with latent stroke increased 4-fold. Cardiac surgery patients are at high risk for perioperative stroke due to underlying comorbidities and invasive technologies used to provide surgeries. The incidence of clinically significant stroke in cardiac surgery ranges from 1 to 6% [7]. According to a meta-analysis of 42 studies (2632 patients), the incidence of occult stroke in patients undergoing CABG is 25% [8]. In a small prospective study, A. https://scientific-jl.com/new 11 22 66 Volume–81_Issue-1_July-2025 JOURNAL OF NEW CENTURY INNOVATIONS Browne et al. (2020) showed that occult stroke developed in 39% of patients after