title: Stroke after aortic valve surgery: results from a prospective cohort.
abstract: BACKGROUND
  The incidence and impact of clinical stroke and silent radiographic cerebral infarction complicating open surgical aortic valve replacement (AVR) are poorly characterized.
  
  
  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.affiliation: 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.).
authors.forename: Steven R
authors.initials: SR
authors.lastname: Messé
authors.affiliation: 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.).
authors.forename: Michael A
authors.initials: MA
authors.lastname: Acker
authors.affiliation: 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.).
authors.forename: Scott E
authors.initials: SE
authors.lastname: Kasner
authors.affiliation: 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.).
authors.forename: Molly
authors.initials: M
authors.lastname: Fanning
authors.affiliation: 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.).
authors.forename: Tania
authors.initials: T
authors.lastname: Giovannetti
authors.affiliation: 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.).
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Ratcliffe
authors.affiliation: 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.).
authors.forename: Michel
authors.initials: M
authors.lastname: Bilello
authors.affiliation: 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.).
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.affiliation: 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.).
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.affiliation: 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.).
authors.forename: W Clark
authors.initials: WC
authors.lastname: Hargrove
authors.affiliation: 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.).
authors.forename: Emile R
authors.initials: ER
authors.lastname: Mohler
authors.affiliation: 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.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Floyd
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology
keywords: aortic valve; magnetic resonance imaging; stroke; surgical procedures