Clinically Silent Cerebral Ischemic Events After Cardiac Surgery

Their Incidence, Regional Vascular Occurrence, and Procedural Dependence

Thomas F. Floyd, Pallav N. Shah, Catherine C. Price, Francis Harris, Sarah J. Ratcliffe, Michael A. Acker, Joseph E. Bavaria, Hind Rahmouni, Bettina Kuersten, Susan Wiegers, Michael L. McGarvey, Joseph Y. Woo, Alberto A. Pochettino, Elias R. Melhem

Research output: Contribution to journalArticle

101 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2160-2166
Number of pages7
JournalAnnals of Thoracic Surgery
Volume81
Issue number6
DOIs
StatePublished - Jun 2006
Externally publishedYes

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Aortic Valve
Thoracic Surgery
Blood Vessels
Coronary Artery Bypass
Incidence
Infarction
Mitral Valve
Diffusion Magnetic Resonance Imaging
Cerebral Infarction
Cardiopulmonary Bypass
Ambulatory Surgical Procedures
Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Clinically Silent Cerebral Ischemic Events After Cardiac Surgery : Their Incidence, Regional Vascular Occurrence, and Procedural Dependence. / Floyd, Thomas F.; Shah, Pallav N.; Price, Catherine C.; Harris, Francis; Ratcliffe, Sarah J.; Acker, Michael A.; Bavaria, Joseph E.; Rahmouni, Hind; Kuersten, Bettina; Wiegers, Susan; McGarvey, Michael L.; Woo, Joseph Y.; Pochettino, Alberto A.; Melhem, Elias R.

In: Annals of Thoracic Surgery, Vol. 81, No. 6, 06.2006, p. 2160-2166.

Research output: Contribution to journalArticle

Floyd, TF, Shah, PN, Price, CC, Harris, F, Ratcliffe, SJ, Acker, MA, Bavaria, JE, Rahmouni, H, Kuersten, B, Wiegers, S, McGarvey, ML, Woo, JY, Pochettino, AA & Melhem, ER 2006, 'Clinically Silent Cerebral Ischemic Events After Cardiac Surgery: Their Incidence, Regional Vascular Occurrence, and Procedural Dependence', Annals of Thoracic Surgery, vol. 81, no. 6, pp. 2160-2166. https://doi.org/10.1016/j.athoracsur.2006.01.080
Floyd, Thomas F. ; Shah, Pallav N. ; Price, Catherine C. ; Harris, Francis ; Ratcliffe, Sarah J. ; Acker, Michael A. ; Bavaria, Joseph E. ; Rahmouni, Hind ; Kuersten, Bettina ; Wiegers, Susan ; McGarvey, Michael L. ; Woo, Joseph Y. ; Pochettino, Alberto A. ; Melhem, Elias R. / Clinically Silent Cerebral Ischemic Events After Cardiac Surgery : Their Incidence, Regional Vascular Occurrence, and Procedural Dependence. In: Annals of Thoracic Surgery. 2006 ; Vol. 81, No. 6. pp. 2160-2166.
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abstract = "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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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.

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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