Pathogenesis and Risk Factors for Cerebral Infarct after Surgical Aortic Valve Replacement

Allie Massaro, Steven R. Messé, Michael A. Acker, Scott E. Kasner, Jose Torres, Molly Fanning, Tania Giovannetti, Sarah J. Ratcliffe, Michel Bilello, Wilson Y. Szeto, Joseph E. Bavaria, Emile R. Mohler, Thomas F. Floyd

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background and Purpose - Stroke is a potentially devastating complication of cardiac surgery. Identifying predictors of radiographic infarct may lead to improved stroke prevention for surgical patients. Methods - We reviewed 129 postoperative brain magnetic resonance imagings from a prospective study of patients undergoing surgical aortic valve replacement. Acute infarcts were classified as watershed or embolic using prespecified criteria. Results - Acute infarct on magnetic resonance imaging was seen in 79 of 129 patients (61%), and interrater reliability for stroke pathogenesis was high (κ=0.93). Embolic infarcts only were identified in 60 patients (46%), watershed only in 2 (2%), and both in 17 (13%). In multivariable logistic regression, embolic infarct was associated with aortic arch atheroma (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.0-12.0; P=0.055), old subcortical infarcts (OR, 5.5; 95% CI, 1.1-26.6; P=0.04), no history of percutaneous transluminal coronary angioplasty or coronary artery bypass graft (OR, 4.0; 95% CI, 1.2-13.7; P=0.03), and higher aortic valve gradient (OR, 1.3 per 5 mm Hg; 95% CI, 1.09-1.6; P=0.004). Watershed infarct was associated with internal carotid artery stenosis ≥70% (OR, 11.7; 95% CI, 1.8-76.8; P=0.01) and increased left ventricular ejection fraction (OR, 1.6 per 5% increase; 95% CI, 1.08-2.4; P=0.02). Conclusions - The principal mechanism of acute cerebral infarction after aortic valve replacement is embolism. There are distinct factors associated with watershed and embolic infarct, some of which may be modifiable.

Original languageEnglish (US)
Pages (from-to)2130-2132
Number of pages3
JournalStroke
Volume47
Issue number8
DOIs
StatePublished - Aug 1 2016

Fingerprint

Aortic Valve
Surgical Instruments
Odds Ratio
Confidence Intervals
Stroke
Magnetic Resonance Imaging
Coronary Balloon Angioplasty
Carotid Stenosis
Cerebral Infarction
Atherosclerotic Plaques
Embolism
Thoracic Aorta
Coronary Artery Bypass
Stroke Volume
Thoracic Surgery
Logistic Models
Prospective Studies
Transplants
Brain

Keywords

  • brain
  • carotid stenosis
  • cerebral infarction
  • embolism
  • magnetic resonance imaging

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Massaro, A., Messé, S. R., Acker, M. A., Kasner, S. E., Torres, J., Fanning, M., ... Floyd, T. F. (2016). Pathogenesis and Risk Factors for Cerebral Infarct after Surgical Aortic Valve Replacement. Stroke, 47(8), 2130-2132. https://doi.org/10.1161/STROKEAHA.116.013970

Pathogenesis and Risk Factors for Cerebral Infarct after Surgical Aortic Valve Replacement. / Massaro, Allie; Messé, Steven R.; Acker, Michael A.; Kasner, Scott E.; Torres, Jose; Fanning, Molly; Giovannetti, Tania; Ratcliffe, Sarah J.; Bilello, Michel; Szeto, Wilson Y.; Bavaria, Joseph E.; Mohler, Emile R.; Floyd, Thomas F.

In: Stroke, Vol. 47, No. 8, 01.08.2016, p. 2130-2132.

Research output: Contribution to journalArticle

Massaro, A, Messé, SR, Acker, MA, Kasner, SE, Torres, J, Fanning, M, Giovannetti, T, Ratcliffe, SJ, Bilello, M, Szeto, WY, Bavaria, JE, Mohler, ER & Floyd, TF 2016, 'Pathogenesis and Risk Factors for Cerebral Infarct after Surgical Aortic Valve Replacement', Stroke, vol. 47, no. 8, pp. 2130-2132. https://doi.org/10.1161/STROKEAHA.116.013970
Massaro A, Messé SR, Acker MA, Kasner SE, Torres J, Fanning M et al. Pathogenesis and Risk Factors for Cerebral Infarct after Surgical Aortic Valve Replacement. Stroke. 2016 Aug 1;47(8):2130-2132. https://doi.org/10.1161/STROKEAHA.116.013970
Massaro, Allie ; Messé, Steven R. ; Acker, Michael A. ; Kasner, Scott E. ; Torres, Jose ; Fanning, Molly ; Giovannetti, Tania ; Ratcliffe, Sarah J. ; Bilello, Michel ; Szeto, Wilson Y. ; Bavaria, Joseph E. ; Mohler, Emile R. ; Floyd, Thomas F. / Pathogenesis and Risk Factors for Cerebral Infarct after Surgical Aortic Valve Replacement. In: Stroke. 2016 ; Vol. 47, No. 8. pp. 2130-2132.
@article{d63ad3deeab649e29c820f38434dab11,
title = "Pathogenesis and Risk Factors for Cerebral Infarct after Surgical Aortic Valve Replacement",
abstract = "Background and Purpose - Stroke is a potentially devastating complication of cardiac surgery. Identifying predictors of radiographic infarct may lead to improved stroke prevention for surgical patients. Methods - We reviewed 129 postoperative brain magnetic resonance imagings from a prospective study of patients undergoing surgical aortic valve replacement. Acute infarcts were classified as watershed or embolic using prespecified criteria. Results - Acute infarct on magnetic resonance imaging was seen in 79 of 129 patients (61{\%}), and interrater reliability for stroke pathogenesis was high (κ=0.93). Embolic infarcts only were identified in 60 patients (46{\%}), watershed only in 2 (2{\%}), and both in 17 (13{\%}). In multivariable logistic regression, embolic infarct was associated with aortic arch atheroma (odds ratio [OR], 3.4; 95{\%} confidence interval [CI], 1.0-12.0; P=0.055), old subcortical infarcts (OR, 5.5; 95{\%} CI, 1.1-26.6; P=0.04), no history of percutaneous transluminal coronary angioplasty or coronary artery bypass graft (OR, 4.0; 95{\%} CI, 1.2-13.7; P=0.03), and higher aortic valve gradient (OR, 1.3 per 5 mm Hg; 95{\%} CI, 1.09-1.6; P=0.004). Watershed infarct was associated with internal carotid artery stenosis ≥70{\%} (OR, 11.7; 95{\%} CI, 1.8-76.8; P=0.01) and increased left ventricular ejection fraction (OR, 1.6 per 5{\%} increase; 95{\%} CI, 1.08-2.4; P=0.02). Conclusions - The principal mechanism of acute cerebral infarction after aortic valve replacement is embolism. There are distinct factors associated with watershed and embolic infarct, some of which may be modifiable.",
keywords = "brain, carotid stenosis, cerebral infarction, embolism, magnetic resonance imaging",
author = "Allie Massaro and Mess{\'e}, {Steven R.} and Acker, {Michael A.} and Kasner, {Scott E.} and Jose Torres and Molly Fanning and Tania Giovannetti and Ratcliffe, {Sarah J.} and Michel Bilello and Szeto, {Wilson Y.} and Bavaria, {Joseph E.} and Mohler, {Emile R.} and Floyd, {Thomas F.}",
year = "2016",
month = "8",
day = "1",
doi = "10.1161/STROKEAHA.116.013970",
language = "English (US)",
volume = "47",
pages = "2130--2132",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - Pathogenesis and Risk Factors for Cerebral Infarct after Surgical Aortic Valve Replacement

AU - Massaro, Allie

AU - Messé, Steven R.

AU - Acker, Michael A.

AU - Kasner, Scott E.

AU - Torres, Jose

AU - Fanning, Molly

AU - Giovannetti, Tania

AU - Ratcliffe, Sarah J.

AU - Bilello, Michel

AU - Szeto, Wilson Y.

AU - Bavaria, Joseph E.

AU - Mohler, Emile R.

AU - Floyd, Thomas F.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Background and Purpose - Stroke is a potentially devastating complication of cardiac surgery. Identifying predictors of radiographic infarct may lead to improved stroke prevention for surgical patients. Methods - We reviewed 129 postoperative brain magnetic resonance imagings from a prospective study of patients undergoing surgical aortic valve replacement. Acute infarcts were classified as watershed or embolic using prespecified criteria. Results - Acute infarct on magnetic resonance imaging was seen in 79 of 129 patients (61%), and interrater reliability for stroke pathogenesis was high (κ=0.93). Embolic infarcts only were identified in 60 patients (46%), watershed only in 2 (2%), and both in 17 (13%). In multivariable logistic regression, embolic infarct was associated with aortic arch atheroma (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.0-12.0; P=0.055), old subcortical infarcts (OR, 5.5; 95% CI, 1.1-26.6; P=0.04), no history of percutaneous transluminal coronary angioplasty or coronary artery bypass graft (OR, 4.0; 95% CI, 1.2-13.7; P=0.03), and higher aortic valve gradient (OR, 1.3 per 5 mm Hg; 95% CI, 1.09-1.6; P=0.004). Watershed infarct was associated with internal carotid artery stenosis ≥70% (OR, 11.7; 95% CI, 1.8-76.8; P=0.01) and increased left ventricular ejection fraction (OR, 1.6 per 5% increase; 95% CI, 1.08-2.4; P=0.02). Conclusions - The principal mechanism of acute cerebral infarction after aortic valve replacement is embolism. There are distinct factors associated with watershed and embolic infarct, some of which may be modifiable.

AB - Background and Purpose - Stroke is a potentially devastating complication of cardiac surgery. Identifying predictors of radiographic infarct may lead to improved stroke prevention for surgical patients. Methods - We reviewed 129 postoperative brain magnetic resonance imagings from a prospective study of patients undergoing surgical aortic valve replacement. Acute infarcts were classified as watershed or embolic using prespecified criteria. Results - Acute infarct on magnetic resonance imaging was seen in 79 of 129 patients (61%), and interrater reliability for stroke pathogenesis was high (κ=0.93). Embolic infarcts only were identified in 60 patients (46%), watershed only in 2 (2%), and both in 17 (13%). In multivariable logistic regression, embolic infarct was associated with aortic arch atheroma (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.0-12.0; P=0.055), old subcortical infarcts (OR, 5.5; 95% CI, 1.1-26.6; P=0.04), no history of percutaneous transluminal coronary angioplasty or coronary artery bypass graft (OR, 4.0; 95% CI, 1.2-13.7; P=0.03), and higher aortic valve gradient (OR, 1.3 per 5 mm Hg; 95% CI, 1.09-1.6; P=0.004). Watershed infarct was associated with internal carotid artery stenosis ≥70% (OR, 11.7; 95% CI, 1.8-76.8; P=0.01) and increased left ventricular ejection fraction (OR, 1.6 per 5% increase; 95% CI, 1.08-2.4; P=0.02). Conclusions - The principal mechanism of acute cerebral infarction after aortic valve replacement is embolism. There are distinct factors associated with watershed and embolic infarct, some of which may be modifiable.

KW - brain

KW - carotid stenosis

KW - cerebral infarction

KW - embolism

KW - magnetic resonance imaging

UR - http://www.scopus.com/inward/record.url?scp=84978137368&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84978137368&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.116.013970

DO - 10.1161/STROKEAHA.116.013970

M3 - Article

C2 - 27382005

AN - SCOPUS:84978137368

VL - 47

SP - 2130

EP - 2132

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 8

ER -