Silent Brain Infarcts Following Cardiac Procedures: A Systematic Review and Meta‐Analysis

Abstract

Background Silent brain infarcts ( SBI ) are increasingly being recognized as an important complication of cardiac procedures as well as a potential surrogate marker for studies on brain injury. The extent of subclinical brain injury is poorly defined. Methods and Results We conducted a systematic review and meta‐analysis utilizing studies of SBI s and focal neurologic deficits following cardiac procedures. Our final analysis included 42 studies with 49 separate intervention groups for a total of 2632 patients. The prevalence of SBI s following transcatheter aortic valve implantation was 0.71 (95% CI 0.64‐0.77); following aortic valve replacement 0.44 (95% CI 0.31‐0.57); in a mixed cardiothoracic surgery group 0.39 (95% CI 0.28‐0.49); coronary artery bypass graft 0.25 (95% CI 0.15‐0.35); percutaneous coronary intervention 0.14 (95% CI 0.10‐0.19); and off‐pump coronary artery bypass 0.14 (0.00‐0.58). The risk ratio of focal neurologic deficits to SBI in aortic valve replacement was 0.22 (95% CI 0.15‐0.32); in off‐pump coronary artery bypass 0.21 (95% CI 0.02‐2.04); with mixed cardiothoracic surgery 0.15 (95% CI 0.07‐0.33); coronary artery bypass graft 0.10 (95% CI 0.05‐0.18); transcatheter aortic valve implantation 0.10 (95% CI 0.07‐0.14); and percutaneous coronary intervention 0.06 (95% CI 0.03‐0.14). The mean number of SBI s per patient was significantly higher in the transcatheter aortic valve implantation group (4.58 ± 2.09) compared with both the aortic valve replacement group (2.16 ± 1.62, P =0.03) and the percutaneous coronary intervention group (1.88 ± 1.02, P =0.03). Conclusions SBI s are a very common complication following cardiac procedures, particularly those involving the aortic valve. The high frequency of SBI s compared with strokes highlights the importance of recording this surrogate measure in cardiac interventional studies. We suggest that further work is required to standardize reporting in order to facilitate the use of SBI s as a routine outcome measure.

Silent brain infarction after minimally invasive cardiac surgery with retrograde perfusion

“…The incidence rate of SBI was 14.9% in patients who underwent MICS with retrograde perfusion. According to a previous study, SBI is common in cardiac surgeries or catheterization 5 . Compared with previous reports about SBI after median sternotomy, the incidence of SBI in this study was low.…”

Schlaganfall als periprozedurale Komplikation kardialer Interventionen

“…In den letzten Jahren wurde eine Vielzahl prospektiver Studien unter (prä-und) postprozeduraler Verwendung der zerebralen MRT veröffentlicht, die mittels diffusion weighted imaging (DWI) prozedurassoziierte akute zerebralen Ischämien bei regelhaft beschwerdefreien Patienten nachweisen konnten (▶Tab. 1) [5,43]. So finden sich (in Abhängigkeit von der Feldstärke und der DWI-Schichtdicke) beispielsweise bei 8-41 % aller Patienten nach linksatrialer Katheterablation und bei 40-93 % aller Patienten nach TAVI akute zerebrale Läsionen [5,20,21,29,43,44], deren mögliche Assoziation mit kognitiven Defiziten (trotz der Heterogenität der zumeist (weit) unter 100 Patienten umfassenden Kohorten) wiederholt postuliert wurde [3,5,43].…”

Silent brain infarction after minimally invasive cardiac surgery with retrograde perfusion

“…The incidence rate of SBI was 14.9% in patients who underwent MICS with retrograde perfusion. According numbers of previous study, SBI is common in cardiac surgeries or catheterization 10 . Compared to previous reports about SBI after median sternotomy, the incidence of SBI in this study was low.…”