TY - JOUR
T1 - Clinically Silent Cerebral Ischemic Events After Cardiac Surgery
T2 - Their Incidence, Regional Vascular Occurrence, and Procedural Dependence
AU - Floyd, Thomas F.
AU - Shah, Pallav N.
AU - Price, Catherine C.
AU - Harris, Francis
AU - Ratcliffe, Sarah J.
AU - Acker, Michael A.
AU - Bavaria, Joseph E.
AU - Rahmouni, Hind
AU - Kuersten, Bettina
AU - Wiegers, Susan
AU - McGarvey, Michael L.
AU - Woo, Joseph Y.
AU - Pochettino, Alberto A.
AU - Melhem, Elias R.
N1 - Funding Information:
We wish to acknowledge the support of grants from the Society for Cardiovascular Anesthesiologists and the Foundation for Anesthesia Education and Research. We wish to also acknowledge the assistance of John Murphy, Research Coordinator, in the conduct of this project.
PY - 2006/6
Y1 - 2006/6
N2 - Background: The reported frequency of stroke after coronary artery bypass grafting varies between 1.5% and 6%, approaches 10% after aortic valve replacement, and may occur in between 40 to 70% in high-risk groups. Clinically silent infarction may be far more frequent and could contribute to long-term cognitive dysfunction in patients after cardiac procedures. Using diffusion-weighted magnetic resonance imaging we document the occurrence, vascular distribution, and procedural dependence of silent infarction after cardiac surgery with cardiopulmonary bypass. We also document the association of preexisting white matter lesions with new postoperative ischemic lesions. Methods: Thirty-four patients underwent T2-weighted fluid attenuated inversion recovery and diffusion-weighted magnetic resonance imaging before and after cardiac surgery with cardiopulmonary bypass for coronary artery bypass grafting, aortic valve replacement, and mitral valve repair or replacement surgery. Images were evaluated by experienced neuroradiologists for number, size, and vascular distribution of lesions. Results: Mean age of participants was 67 ± 15 years. Imaging occurred before and 6 ± 2 days after surgery. New cerebral infarctions were evident in 6 of 34 patients (18%), were often multiple, and in 67% of patients were clinically silent. The occurrence of new infarctions by surgical procedure was as follows: aortic valve replacement (2 of 6), coronary artery bypass grafting and aortic valve replacement (3 of 8), aortic valve replacement with root replacement (1 of 1), coronary artery bypass grafting and mitral valve repair or replacement (0 of 4), mitral valve repair or replacement (0 of 2), and isolated coronary artery bypass grafting (0 of 13). New infarction occurred in 6 of 15 (40%) of all procedures involving aortic valve replacement. The severity of preexisting white matter lesions trended toward predicting the occurrence of new lesions (p = 0.055). Conclusions: Diffusion-weighted imaging reveals new cerebral infarctions in nearly 40% of patients after aortic valve replacement.
AB - Background: The reported frequency of stroke after coronary artery bypass grafting varies between 1.5% and 6%, approaches 10% after aortic valve replacement, and may occur in between 40 to 70% in high-risk groups. Clinically silent infarction may be far more frequent and could contribute to long-term cognitive dysfunction in patients after cardiac procedures. Using diffusion-weighted magnetic resonance imaging we document the occurrence, vascular distribution, and procedural dependence of silent infarction after cardiac surgery with cardiopulmonary bypass. We also document the association of preexisting white matter lesions with new postoperative ischemic lesions. Methods: Thirty-four patients underwent T2-weighted fluid attenuated inversion recovery and diffusion-weighted magnetic resonance imaging before and after cardiac surgery with cardiopulmonary bypass for coronary artery bypass grafting, aortic valve replacement, and mitral valve repair or replacement surgery. Images were evaluated by experienced neuroradiologists for number, size, and vascular distribution of lesions. Results: Mean age of participants was 67 ± 15 years. Imaging occurred before and 6 ± 2 days after surgery. New cerebral infarctions were evident in 6 of 34 patients (18%), were often multiple, and in 67% of patients were clinically silent. The occurrence of new infarctions by surgical procedure was as follows: aortic valve replacement (2 of 6), coronary artery bypass grafting and aortic valve replacement (3 of 8), aortic valve replacement with root replacement (1 of 1), coronary artery bypass grafting and mitral valve repair or replacement (0 of 4), mitral valve repair or replacement (0 of 2), and isolated coronary artery bypass grafting (0 of 13). New infarction occurred in 6 of 15 (40%) of all procedures involving aortic valve replacement. The severity of preexisting white matter lesions trended toward predicting the occurrence of new lesions (p = 0.055). Conclusions: Diffusion-weighted imaging reveals new cerebral infarctions in nearly 40% of patients after aortic valve replacement.
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U2 - 10.1016/j.athoracsur.2006.01.080
DO - 10.1016/j.athoracsur.2006.01.080
M3 - Article
C2 - 16731147
AN - SCOPUS:33646833240
SN - 0003-4975
VL - 81
SP - 2160
EP - 2166
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 6
ER -