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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, Cardiovascular Care Team, 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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