Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada
Jessica Spence, MD
Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada; Department of Anesthesia, Hamilton General Hospital, Hamilton, Ontario, Canada
Patricia Power, MSc
Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada
Ingrid Copland, CCRA
Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada
Rajibul Mian, PhD
Department of Statistics, Population Health Research Institute, Hamilton, Ontario, Canada
Stephanie Gagnon, BHSc
Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada
Shauna Kennedy, MD
Department of Radiology, Hamilton General Hospital, Hamilton, Ontario, Canada
Mukul Sharma, MD
Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology, Hamilton General Hospital, Hamilton, Ontario, Canada
André Lamy, MD
Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada; Department of Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada; Address for reprints: André Lamy, MD, Department of Perioperative Medicine, Population Health Research Institute, DBCVSRI Room C1-112, 20 Copeland Ave, Hamilton, Ontario L8L 2X2 Canada.
Objectives: Covert stroke is a complication of coronary artery bypass graft surgery that is increasingly recognized as a serious problem. In noncardiac surgery settings, covert stroke is associated with the development of delirium, long-term cognitive decline, and future clinical stroke. Therefore, we sought to determine the feasibility of conducting a large, prospective cohort study of the influence of covert stroke on neurocognitive outcomes in patients undergoing coronary artery bypass graft surgery. Methods: NeuroVISION Cardiac pilot was a prospective cohort study enrolling patients aged ≥21 years undergoing isolated coronary artery bypass graft surgery to receive diffusion-weighted magnetic resonance imaging of the brain after surgery to identify patients with covert stroke. Patients were screened for postoperative delirium in-hospital and were administered questionnaires of cognitive and global function (once before and twice after surgery). Regional cerebral oxygen saturation was recorded during surgery using near-infrared spectroscopy. Results: Between March 27, 2017, and February 11, 2018, 50 of 66 patients enrolled (76%) completed the brain magnetic resonance imaging (1 patient per week). Among the 49 patients included in the analysis, 19 (39%; 95% confidence interval, 26%-53%) experienced perioperative covert stroke and 3 (6%) had a clinical stroke within 30 days of surgery. Postoperative delirium occurred in 5 (26%) patients with covert stroke and in 3 (10%) patients who did not experience covert stroke. Conclusions: The NeuroVISION Cardiac pilot study established the feasibility of conducting a large, prospective cohort study of the determinants and consequences of covert stroke in patients undergoing coronary artery bypass graft surgery.
