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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Pathogenesis and Risk Factors for Cerebral Infarct After Surgical Aortic Valve Replacement

Allie Massaro1, Steven R Messé2, Michael A Acker1

  • 1From the Departments of Neurology (A.M., S.R.M., S.E.K., J.T.) and Radiology (M.B.), and Section of Vascular Medicine, Cardiovascular Division, Department of Medicine (E.R.M.), Hospital of the University of Pennsylvania, Philadelphia; Division of Cardiovascular Surgery, Department of Surgery (M.A.A., M.F., W.Y.S., J.E.B.) and Department of Biostatistics and Epidemiology (S.J.R.), University of Pennsylvania, Philadelphia; Department of Psychology, Temple University, Philadelphia, PA (T.G.); and Department of Anesthesia and Critical Care, State University of New York, Stony Brook (T.F.F.).

Stroke
|July 7, 2016
PubMed

Insights

Stroke after aortic valve replacement is common, often embolic. Identifying predictors like aortic arch atheroma and carotid stenosis may improve stroke prevention strategies for cardiac surgery patients.

Area of Science:

  • Neurology
  • Cardiology
  • Radiology

Background:

  • Stroke is a serious complication following cardiac surgery.
  • Identifying stroke predictors can enhance patient care and prevention strategies.

Purpose of the Study:

  • To identify predictors of radiographic infarct after surgical aortic valve replacement.
  • To differentiate between embolic and watershed infarct mechanisms.

Main Methods:

  • Reviewed 129 postoperative brain MRIs from patients undergoing surgical aortic valve replacement.
  • Classified acute infarcts as watershed or embolic using defined criteria.
  • Utilized multivariable logistic regression to identify associated factors.

Main Results:

  • 61% of patients showed acute infarcts on MRI.
  • Embolic infarcts were associated with aortic arch atheroma, prior infarcts, no history of revascularization, and higher aortic valve gradient.
  • Watershed infarcts were linked to severe internal carotid artery stenosis and increased left ventricular ejection fraction.

Conclusions:

  • Embolism is the primary cause of acute cerebral infarction post-aortic valve replacement.
  • Distinct factors are associated with watershed and embolic infarcts.
  • Some identified predictors for stroke are potentially modifiable, offering targets for intervention.
Abstract

Keywords:
braincarotid stenosiscerebral infarctionembolismmagnetic resonance imaging

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