Stroke After Aortic Valve Surgery

Author:

Messé Steven R.1,Acker Michael A.1,Kasner Scott E.1,Fanning Molly1,Giovannetti Tania1,Ratcliffe Sarah J.1,Bilello Michel1,Szeto Wilson Y.1,Bavaria Joseph E.1,Hargrove W. Clark1,Mohler Emile R.1,Floyd Thomas F.1,Acker Michael A.2,Bavaria Joseph E.2,Floyd Thomas F.3,Giovanetti Tania4,Hargrove W. Clark2,Kasner Scott E.5,Messé Steven R.5,Matthai William H.6,Mohler Emile R.6,Morris Rohinton J.2,Pochettino Alberto A.7,Price Catherine E. C.8,Ratcliffe Sarah J.9,Selnes Ola A.10,Szeto Wilson Y.2,Woo Y. Joseph2,Desai Nimesh D.2,Augostides John G.11,Cheung Albert T.11,Hanson C. William11,Horak Jiri11,Kohl Benjamin A.11,Kukafka Jeremy D.11,Levy Warren J.11,Mickler Thomas A.11,Milas Bonnie L.11,Savino Joseph S.11,Vernick William J.11,Weiss Stuart J.11,

Affiliation:

1. From the Departments of Neurology (S.R.M., S.E.K.), Surgery (M.A.A., M.F., W.Y.S., J.E.B., W.C.H.), and Radiology (M.B.), and Section of Vascular Medicine, Cardiovascular Division, Department of Medicine (E.R.M.), Hospital of the University of Pennsylvania, Philadelphia, PA; Department of Psychology, Temple University, Philadelphia, PA (T.G.); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA (S.J.R.); Department of Anesthesia and Critical Care, State...

2. Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA

3. Department of Anesthesiology & Critical Care, State University of New York, Stony Brook, NY

4. Department of Psychology, Temple University, Philadelphia, PA

5. Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA

6. Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA

7. Department of Surgery, Mayo Clinic, Rochester, MN

8. Department of Clinical and Health Psychology, University of Florida, Gainesville, FL

9. Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA

10. Department of Neurology, Johns Hopkins University Hospital, Baltimore, MD

11. Department of Anesthesiology & Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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