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Impact of perioperative infarcts after cardiac surgery

Patel, Nikil; Horsfield, Mark A.; Banahan, Caroline; Janus, Justyna; Masters, Katie; Morlese, John; Egan, Vincent; Chung, Emma M.L.

Authors

Nikil Patel

Mark A. Horsfield

Caroline Banahan

Justyna Janus

Katie Masters

John Morlese

Vincent Egan

Emma M.L. Chung



Abstract

Background and Purpose: Brain injury after cardiac surgery is a serious concern for patients and their families. The purpose of this study was to use 3-T fluid attenuated inversion recovery MRI to characterize new and preexisting cerebral ischemic lesions in patients undergoing cardiac surgery and to test whether the accumulation of new ischemic lesions adversely affects cognition.

Methods: Digital comparison of before and after fluid attenuated inversion recovery MRI images was performed for 77 cardiac surgery patients. The burden of preexisting versus new ischemic lesions was quantified and compared with the results of baseline and postoperative neuropsychological testing.

Results: After surgery, new lesions were identified in 31% of patients, averaging 0.5 lesions per patient (67 mm3 [0.004%] of brain tissue). Patients with preexisting lesions were 10× more likely to receive new lesions after surgery than patients without preexisting lesions. Preexisting ischemic lesions were observed in 64% of patients, averaging 19.4 lesions (1542 mm3 [0.1%] of brain tissue). 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 (10 lesions; median volume, 128 mm3; volume range, 13–1383 mm3), which is consistent with a cardioembolic source of particulate emboli. Overall, the incidence of postoperative cognitive decline was 46% and was independent of whether new lesions were present.

Conclusions: New lesions after cardiac surgery added a small (≈4%) contribution to the burden of preexisting cerebrovascular disease and did not seem to affect cognitive function.

Journal Article Type Article
Publication Date Feb 3, 2015
Journal Stroke
Print ISSN 0039-2499
Electronic ISSN 1524-4628
Publisher American Heart Association
Peer Reviewed Peer Reviewed
Volume 46
Issue 3
APA6 Citation Patel, N., Horsfield, M. A., Banahan, C., Janus, J., Masters, K., Morlese, J., …Chung, E. M. (2015). Impact of perioperative infarcts after cardiac surgery. Stroke, 46(3), doi:10.1161/STROKEAHA.114.007533
DOI https://doi.org/10.1161/STROKEAHA.114.007533
Keywords cerebral infarction, magnetic resonance imaging, neuropsychology, thoracic surgery
Publisher URL http://stroke.ahajournals.org/content/46/3/680
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf





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