Steven R Messé1, Michael A Acker1, Scott E Kasner1, Molly Fanning1, Tania Giovannetti1, Sarah J Ratcliffe1, Michel Bilello1, Wilson Y Szeto1, Joseph E Bavaria1, W Clark Hargrove1, Emile R Mohler1, Thomas F Floyd2. 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 University of New York, Stony Brook, NY (T.F.F.). 2. 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 University of New York, Stony Brook, NY (T.F.F.). thomas.floyd@stonybrookmedicine.edu.
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.
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.
Authors: Benoit Daneault; Ajay J Kirtane; Susheel K Kodali; Mathew R Williams; Philippe Genereux; George R Reiss; Craig R Smith; Jeffrey W Moses; Martin B Leon Journal: J Am Coll Cardiol Date: 2011-11-15 Impact factor: 24.094
Authors: Craig R Smith; Martin B Leon; Michael J Mack; D Craig Miller; Jeffrey W Moses; Lars G Svensson; E Murat Tuzcu; John G Webb; Gregory P Fontana; Raj R Makkar; Mathew Williams; Todd Dewey; Samir Kapadia; Vasilis Babaliaros; Vinod H Thourani; Paul Corso; Augusto D Pichard; Joseph E Bavaria; Howard C Herrmann; Jodi J Akin; William N Anderson; Duolao Wang; Stuart J Pocock Journal: N Engl J Med Date: 2011-06-05 Impact factor: 91.245
Authors: Raj R Makkar; Gregory P Fontana; Hasan Jilaihawi; Samir Kapadia; Augusto D Pichard; Pamela S Douglas; Vinod H Thourani; Vasilis C Babaliaros; John G Webb; Howard C Herrmann; Joseph E Bavaria; Susheel Kodali; David L Brown; Bruce Bowers; Todd M Dewey; Lars G Svensson; Murat Tuzcu; Jeffrey W Moses; Matthew R Williams; Robert J Siegel; Jodi J Akin; William N Anderson; Stuart Pocock; Craig R Smith; Martin B Leon Journal: N Engl J Med Date: 2012-03-26 Impact factor: 91.245
Authors: Charlotte Mérie; Lars Køber; Peter Skov Olsen; Charlotte Andersson; Jan Skov Jensen; Christian Torp-Pedersen Journal: Stroke Date: 2011-10-27 Impact factor: 7.914
Authors: Eelco J Veen; Maryska L G Janssen-Heijnen; Eelke Bosma; Maryska A C de Jongh; Jan A Roukema Journal: J Surg Res Date: 2010-09-24 Impact factor: 2.192
Authors: Alexandra J Lansky; Steven R Messé; Adam M Brickman; Michael Dwyer; H Bart van der Worp; Ronald M Lazar; Cody G Pietras; Kevin J Abrams; Eugene McFadden; Nils H Petersen; Jeffrey Browndyke; Bernard Prendergast; Vivian G Ng; Donald E Cutlip; Samir Kapadia; Mitchell W Krucoff; Axel Linke; Claudia Scala Moy; Joachim Schofer; Gerrit-Anne van Es; Renu Virmani; Jeffrey Popma; Michael K Parides; Susheel Kodali; Michel Bilello; Robert Zivadinov; Joseph Akar; Karen L Furie; Daryl Gress; Szilard Voros; Jeffrey Moses; David Greer; John K Forrest; David Holmes; Arie P Kappetein; Michael Mack; Andreas Baumbach Journal: Eur Heart J Date: 2018-05-14 Impact factor: 29.983
Authors: Chia-Shing Yang; Erik S Marshall; Zaher Fanari; Michael J Kostal; Joseph T West; Paul Kolm; William S Weintraub; Andrew J Doorey Journal: Catheter Cardiovasc Interv Date: 2015-05-29 Impact factor: 2.692
Authors: Michael J Mack; Michael A Acker; Annetine C Gelijns; Jessica R Overbey; Michael K Parides; Jeffrey N Browndyke; Mark A Groh; Alan J Moskowitz; Neal O Jeffries; Gorav Ailawadi; Vinod H Thourani; Ellen G Moquete; Alexander Iribarne; Pierre Voisine; Louis P Perrault; Michael E Bowdish; Michel Bilello; Christos Davatzikos; Ralph F Mangusan; Rachelle A Winkle; Peter K Smith; Robert E Michler; Marissa A Miller; Karen L O'Sullivan; Wendy C Taddei-Peters; Eric A Rose; Richard D Weisel; Karen L Furie; Emilia Bagiella; Claudia Scala Moy; Patrick T O'Gara; Steven R Messé Journal: JAMA Date: 2017-08-08 Impact factor: 56.272
Authors: Susheel Kodali; Vinod H Thourani; Jonathon White; S Chris Malaisrie; Scott Lim; Kevin L Greason; Mathew Williams; Mayra Guerrero; Andrew C Eisenhauer; Samir Kapadia; Dean J Kereiakes; Howard C Herrmann; Vasilis Babaliaros; Wilson Y Szeto; Rebecca T Hahn; Philippe Pibarot; Neil J Weissman; Jonathon Leipsic; Philipp Blanke; Brian K Whisenant; Rakesh M Suri; Raj R Makkar; Girma M Ayele; Lars G Svensson; John G Webb; Michael J Mack; Craig R Smith; Martin B Leon Journal: Eur Heart J Date: 2016-03-31 Impact factor: 29.983
Authors: Michael E Bowdish; Dawn S Hui; John D Cleveland; Wendy J Mack; Raina Sinha; Rupesh Ranjan; Robbin G Cohen; Craig J Baker; Mark J Cunningham; Mark L Barr; Vaughn A Starnes Journal: Eur J Cardiothorac Surg Date: 2015-03-06 Impact factor: 4.191