Perioperative Stroke After Cardiac Surgery | Journal Scan

Study Questions:

Do new or pre-existing cerebral ischemic lesions affect cognition in patients undergoing cardiac surgery?

Methods:

Digital comparison of 3-T fluid attenuated inversion recovery magnetic resonance imaging (MRI) was performed among 77 patients before and after cardiac surgery. The burden of pre-existing versus new ischemic lesions was quantified, and compared with the results of baseline and postoperative neuropsychological testing.

Results:

Pre-existing ischemic lesions were observed in 64% of patients, averaging 19.4 lesions (1542 mm3 [0.1%] of brain tissue). After surgery, new lesions were identified in 24 of 77 (31%) patients, averaging 0.5 lesions per patient (67 mm3 [0.004%] of brain tissue). Patients with pre-existing ischemic lesions were 10 times more likely to have new lesions identified after surgery than were patients without pre-existing lesions. New lesions in the left hemisphere were significantly smaller and more numerous (29 lesions; median volume, 44 mm3; volume range, 5-404 mm3) than those on the right hemisphere (10 lesions; median volume, 128 mm3; volume range, 13-1383 mm3), consistent with particulate cardioemboli. Overall, a postoperative decline in neuropsychological test performance was present in 35 of 77 (46%) patients. Of these, the majority (24/ 35 [69%]) had no new postoperative MRI lesions; there were no significant differences in the magnitude of decline between patients with and without new cerebral ischemic lesions.

Conclusions:

The authors concluded that new lesions after cardiac surgery added a small (approximately 4%) contribution to the burden of pre-existing cerebrovascular disease, but did not seem to affect cognitive function.

Perspective:

Perhaps as expected, many patients undergoing cardiac surgery had MRI evidence of prior cerebral ischemic lesions. Although there was a small increase in the number of lesions after cardiac surgery, at least in the short term, these were not correlated with measurable changes in cognition.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Vascular Medicine, Cardiac Surgery and Arrhythmias, Interventions and Imaging, Interventions and Vascular Medicine, Magnetic Resonance Imaging

Keywords: Stroke, Cardiac Surgical Procedures, Thoracic Surgery, Brain, Magnetic Resonance Imaging, Ischemia, Neuropsychological Tests, Cognition, Cerebral Infarction


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