Stroke after aortic valve surgery: Results from a prospective cohort

Steven R. Messé, Michael A. Acker, Scott E. Kasner, Molly Fanning, Tania Giovannetti, Sarah J. Ratcliffe, Michel Bilello, Wilson Y. Szeto, Joseph E. Bavaria, W. Clark Hargrove, Emile R. Mohler, Thomas F. Floyd, William H. Matthai, Rohinton J. Morris, Alberto A. Pochettino, Catherine E.C. Price, Ola A. Selnes, Y. Joseph Woo, Nimesh D. Desai, John G. AugostidesAlbert T. Cheung, C. William Hanson, Jiri Horak, Benjamin A. Kohl, Jeremy D. Kukafka, Warren J. Levy, Thomas A. Mickler, Bonnie L. Milas, Joseph S. Savino, William J. Vernick, Stuart J. Weiss

Research output: Contribution to journalArticle

101 Citations (Scopus)

Abstract

BACKGROUND - : The incidence and impact of clinical stroke and silent radiographic cerebral infarction complicating open surgical aortic valve replacement (AVR) are poorly characterized. METHODS AND RESULTS - : We performed a prospective cohort study of subjects ≥65 years of age who were undergoing AVR for calcific aortic stenosis. Subjects were evaluated by neurologists preoperatively and postoperatively and underwent postoperative magnetic resonance imaging. Over a 4-year period, 196 subjects were enrolled at 2 sites (mean age, 75.8±6.2 years; 36% women; 6% nonwhite). Clinical strokes were detected in 17%, transient ischemic attack in 2%, and in-hospital mortality was 5%. The frequency of stroke in the Society for Thoracic Surgery database in this cohort was 7%. Most strokes were mild; the median National Institutes of Health Stroke Scale was 3 (interquartile range, 1-9). Clinical stroke was associated with increased length of stay (median, 12 versus 10 days; P=0.02). Moderate or severe stroke (National Institutes of Health Stroke Scale ≥10) occurred in 8 (4%) and was strongly associated with in-hospital mortality (38% versus 4%; P=0.005). Of the 109 stroke-free subjects with postoperative magnetic resonance imaging, silent infarct was identified in 59 (54%). Silent infarct was not associated with in-hospital mortality or increased length of stay. CONCLUSIONS - : Clinical stroke after AVR was more common than reported previously, more than double for this same cohort in the Society for Thoracic Surgery database, and silent cerebral infarctions were detected in more than half of the patients undergoing AVR. Clinical stroke complicating AVR is associated with increased length of stay and mortality.

Original languageEnglish (US)
Pages (from-to)2253-2261
Number of pages9
JournalCirculation
Volume129
Issue number22
DOIs
StatePublished - Jun 3 2014

Fingerprint

Aortic Valve
Stroke
Hospital Mortality
Length of Stay
Cerebral Infarction
National Institutes of Health (U.S.)
Thoracic Surgery
Magnetic Resonance Imaging
Databases
Transient Ischemic Attack
Surgical Instruments
Cohort Studies
Prospective Studies
Mortality
Incidence

Keywords

  • aortic valve
  • magnetic resonance imaging
  • stroke
  • surgical procedures

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Messé, S. R., Acker, M. A., Kasner, S. E., Fanning, M., Giovannetti, T., Ratcliffe, S. J., ... Weiss, S. J. (2014). Stroke after aortic valve surgery: Results from a prospective cohort. Circulation, 129(22), 2253-2261. https://doi.org/10.1161/CIRCULATIONAHA.113.005084

Stroke after aortic valve surgery : Results from a prospective cohort. / Messé, Steven R.; Acker, Michael A.; Kasner, Scott E.; Fanning, Molly; Giovannetti, Tania; Ratcliffe, Sarah J.; Bilello, Michel; Szeto, Wilson Y.; Bavaria, Joseph E.; Hargrove, W. Clark; Mohler, Emile R.; Floyd, Thomas F.; Matthai, William H.; Morris, Rohinton J.; Pochettino, Alberto A.; Price, Catherine E.C.; Selnes, Ola A.; Woo, Y. Joseph; Desai, Nimesh D.; Augostides, John G.; Cheung, Albert T.; Hanson, C. William; Horak, Jiri; Kohl, Benjamin A.; Kukafka, Jeremy D.; Levy, Warren J.; Mickler, Thomas A.; Milas, Bonnie L.; Savino, Joseph S.; Vernick, William J.; Weiss, Stuart J.

In: Circulation, Vol. 129, No. 22, 03.06.2014, p. 2253-2261.

Research output: Contribution to journalArticle

Messé, SR, Acker, MA, Kasner, SE, Fanning, M, Giovannetti, T, Ratcliffe, SJ, Bilello, M, Szeto, WY, Bavaria, JE, Hargrove, WC, Mohler, ER, Floyd, TF, Matthai, WH, Morris, RJ, Pochettino, AA, Price, CEC, Selnes, OA, Woo, YJ, Desai, ND, Augostides, JG, Cheung, AT, Hanson, CW, Horak, J, Kohl, BA, Kukafka, JD, Levy, WJ, Mickler, TA, Milas, BL, Savino, JS, Vernick, WJ & Weiss, SJ 2014, 'Stroke after aortic valve surgery: Results from a prospective cohort', Circulation, vol. 129, no. 22, pp. 2253-2261. https://doi.org/10.1161/CIRCULATIONAHA.113.005084
Messé SR, Acker MA, Kasner SE, Fanning M, Giovannetti T, Ratcliffe SJ et al. Stroke after aortic valve surgery: Results from a prospective cohort. Circulation. 2014 Jun 3;129(22):2253-2261. https://doi.org/10.1161/CIRCULATIONAHA.113.005084
Messé, Steven R. ; Acker, Michael A. ; Kasner, Scott E. ; Fanning, Molly ; Giovannetti, Tania ; Ratcliffe, Sarah J. ; Bilello, Michel ; Szeto, Wilson Y. ; Bavaria, Joseph E. ; Hargrove, W. Clark ; Mohler, Emile R. ; Floyd, Thomas F. ; Matthai, William H. ; Morris, Rohinton J. ; Pochettino, Alberto A. ; Price, Catherine E.C. ; Selnes, Ola A. ; Woo, Y. Joseph ; Desai, Nimesh D. ; Augostides, John G. ; Cheung, Albert T. ; Hanson, C. William ; Horak, Jiri ; Kohl, Benjamin A. ; Kukafka, Jeremy D. ; Levy, Warren J. ; Mickler, Thomas A. ; Milas, Bonnie L. ; Savino, Joseph S. ; Vernick, William J. ; Weiss, Stuart J. / Stroke after aortic valve surgery : Results from a prospective cohort. In: Circulation. 2014 ; Vol. 129, No. 22. pp. 2253-2261.
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abstract = "BACKGROUND - : The incidence and impact of clinical stroke and silent radiographic cerebral infarction complicating open surgical aortic valve replacement (AVR) are poorly characterized. METHODS AND RESULTS - : We performed a prospective cohort study of subjects ≥65 years of age who were undergoing AVR for calcific aortic stenosis. Subjects were evaluated by neurologists preoperatively and postoperatively and underwent postoperative magnetic resonance imaging. Over a 4-year period, 196 subjects were enrolled at 2 sites (mean age, 75.8±6.2 years; 36{\%} women; 6{\%} nonwhite). Clinical strokes were detected in 17{\%}, transient ischemic attack in 2{\%}, and in-hospital mortality was 5{\%}. The frequency of stroke in the Society for Thoracic Surgery database in this cohort was 7{\%}. Most strokes were mild; the median National Institutes of Health Stroke Scale was 3 (interquartile range, 1-9). Clinical stroke was associated with increased length of stay (median, 12 versus 10 days; P=0.02). Moderate or severe stroke (National Institutes of Health Stroke Scale ≥10) occurred in 8 (4{\%}) and was strongly associated with in-hospital mortality (38{\%} versus 4{\%}; P=0.005). Of the 109 stroke-free subjects with postoperative magnetic resonance imaging, silent infarct was identified in 59 (54{\%}). Silent infarct was not associated with in-hospital mortality or increased length of stay. CONCLUSIONS - : Clinical stroke after AVR was more common than reported previously, more than double for this same cohort in the Society for Thoracic Surgery database, and silent cerebral infarctions were detected in more than half of the patients undergoing AVR. Clinical stroke complicating AVR is associated with increased length of stay and mortality.",
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TY - JOUR

T1 - Stroke after aortic valve surgery

T2 - Results from a prospective cohort

AU - Messé, Steven R.

AU - Acker, Michael A.

AU - Kasner, Scott E.

AU - Fanning, Molly

AU - Giovannetti, Tania

AU - Ratcliffe, Sarah J.

AU - Bilello, Michel

AU - Szeto, Wilson Y.

AU - Bavaria, Joseph E.

AU - Hargrove, W. Clark

AU - Mohler, Emile R.

AU - Floyd, Thomas F.

AU - Matthai, William H.

AU - Morris, Rohinton J.

AU - Pochettino, Alberto A.

AU - Price, Catherine E.C.

AU - Selnes, Ola A.

AU - Woo, Y. Joseph

AU - Desai, Nimesh D.

AU - Augostides, John G.

AU - Cheung, Albert T.

AU - Hanson, C. William

AU - Horak, Jiri

AU - Kohl, Benjamin A.

AU - Kukafka, Jeremy D.

AU - Levy, Warren J.

AU - Mickler, Thomas A.

AU - Milas, Bonnie L.

AU - Savino, Joseph S.

AU - Vernick, William J.

AU - Weiss, Stuart J.

PY - 2014/6/3

Y1 - 2014/6/3

N2 - BACKGROUND - : The incidence and impact of clinical stroke and silent radiographic cerebral infarction complicating open surgical aortic valve replacement (AVR) are poorly characterized. METHODS AND RESULTS - : We performed a prospective cohort study of subjects ≥65 years of age who were undergoing AVR for calcific aortic stenosis. Subjects were evaluated by neurologists preoperatively and postoperatively and underwent postoperative magnetic resonance imaging. Over a 4-year period, 196 subjects were enrolled at 2 sites (mean age, 75.8±6.2 years; 36% women; 6% nonwhite). Clinical strokes were detected in 17%, transient ischemic attack in 2%, and in-hospital mortality was 5%. The frequency of stroke in the Society for Thoracic Surgery database in this cohort was 7%. Most strokes were mild; the median National Institutes of Health Stroke Scale was 3 (interquartile range, 1-9). Clinical stroke was associated with increased length of stay (median, 12 versus 10 days; P=0.02). Moderate or severe stroke (National Institutes of Health Stroke Scale ≥10) occurred in 8 (4%) and was strongly associated with in-hospital mortality (38% versus 4%; P=0.005). Of the 109 stroke-free subjects with postoperative magnetic resonance imaging, silent infarct was identified in 59 (54%). Silent infarct was not associated with in-hospital mortality or increased length of stay. CONCLUSIONS - : Clinical stroke after AVR was more common than reported previously, more than double for this same cohort in the Society for Thoracic Surgery database, and silent cerebral infarctions were detected in more than half of the patients undergoing AVR. Clinical stroke complicating AVR is associated with increased length of stay and mortality.

AB - BACKGROUND - : The incidence and impact of clinical stroke and silent radiographic cerebral infarction complicating open surgical aortic valve replacement (AVR) are poorly characterized. METHODS AND RESULTS - : We performed a prospective cohort study of subjects ≥65 years of age who were undergoing AVR for calcific aortic stenosis. Subjects were evaluated by neurologists preoperatively and postoperatively and underwent postoperative magnetic resonance imaging. Over a 4-year period, 196 subjects were enrolled at 2 sites (mean age, 75.8±6.2 years; 36% women; 6% nonwhite). Clinical strokes were detected in 17%, transient ischemic attack in 2%, and in-hospital mortality was 5%. The frequency of stroke in the Society for Thoracic Surgery database in this cohort was 7%. Most strokes were mild; the median National Institutes of Health Stroke Scale was 3 (interquartile range, 1-9). Clinical stroke was associated with increased length of stay (median, 12 versus 10 days; P=0.02). Moderate or severe stroke (National Institutes of Health Stroke Scale ≥10) occurred in 8 (4%) and was strongly associated with in-hospital mortality (38% versus 4%; P=0.005). Of the 109 stroke-free subjects with postoperative magnetic resonance imaging, silent infarct was identified in 59 (54%). Silent infarct was not associated with in-hospital mortality or increased length of stay. CONCLUSIONS - : Clinical stroke after AVR was more common than reported previously, more than double for this same cohort in the Society for Thoracic Surgery database, and silent cerebral infarctions were detected in more than half of the patients undergoing AVR. Clinical stroke complicating AVR is associated with increased length of stay and mortality.

KW - aortic valve

KW - magnetic resonance imaging

KW - stroke

KW - surgical procedures

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