Silent cerebral ischemia detected by magnetic resonance imaging can predict postoperative delirium after total arch replacement for aneurysmCentral MessagePerspective

Keisuke Shibagaki, MD; Tomonori Shirasaka, MD, PhD; Jun Sawada, MD, PhD; Yasuaki Saijo, MD, PhD; Shingo Kunioka, MD; Yuta Kikuchi, MD; Hiroyuki Kamiya, MD, PhD

JTCVS Open (Jun 2022)

Silent cerebral ischemia detected by magnetic resonance imaging can predict postoperative delirium after total arch replacement for aneurysmCentral MessagePerspective

Keisuke Shibagaki, MD,
Tomonori Shirasaka, MD, PhD,
Jun Sawada, MD, PhD,
Yasuaki Saijo, MD, PhD,
Shingo Kunioka, MD,
Yuta Kikuchi, MD,
Hiroyuki Kamiya, MD, PhD

Affiliations

Keisuke Shibagaki, MD: Department of Cardiac Surgery, Asahikawa Medical University, Hokkaido, Japan
Tomonori Shirasaka, MD, PhD: Department of Cardiac Surgery, Asahikawa Medical University, Hokkaido, Japan; Address for reprints: Tomonori Shirasaka, MD, PhD, Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan.
Jun Sawada, MD, PhD: Division of Neurology, Department of Internal Medicine, Asahikawa Medical University, Hokkaido, Japan
Yasuaki Saijo, MD, PhD: Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University, Hokkaido, Japan
Shingo Kunioka, MD: Department of Cardiac Surgery, Asahikawa Medical University, Hokkaido, Japan
Yuta Kikuchi, MD: Department of Cardiac Surgery, Asahikawa Medical University, Hokkaido, Japan
Hiroyuki Kamiya, MD, PhD: Department of Cardiac Surgery, Asahikawa Medical University, Hokkaido, Japan

Journal volume & issue: Vol. 10
pp. 87 – 96

Abstract

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Objective: To identify whether preoperative magnetic resonance imaging findings of the brain can predict postoperative delirium in patients who undergo arch replacement for aneurysms. Methods: Overall, 193 patients who underwent aortic replacement for the first time at a single institution between April 2014 and September 2020 were enrolled in this retrospective study. After we excluded patients with acute aortic dissection, no preoperative magnetic resonance imaging findings of the brain, and postoperative cerebral infarction, 50 patients were included and divided into 2 groups, according to their confusion scale results: postoperative delirium (group D) and nonpostoperative delirium (group ND). Preoperative magnetic resonance imaging findings of the brain were classified into lacunar stroke, periventricular hyperintensity, and deep subcortical white matter hyperintensity groups; the latter 2 groups were further classified based on the Fazekas scale, grade 0 to 3. Results: There were 23 patients (46%) in group D and 27 (54%) in group ND. The mean age was significantly greater in group D than in group ND (75 vs 70 years; P = .007). The mean operative time was significantly longer in group D than in group ND (447 vs 384 minutes; P = .024). As for preoperative magnetic resonance imaging findings of the brain, there were significantly more lacunar stroke cases in group D than in group ND (P = .027). In multivariable logistic regression with stepwise selection, high-grade periventricular hyperintensity was significantly related to postoperative delirium (odds ratio, 9.38; 95% confidence interval, 1.55-56.56; P = .015). Conclusions: Silent cerebral ischemia detected by preoperative magnetic resonance imaging of the brain was a significant risk factor for postoperative delirium.

Published in JTCVS Open

ISSN: 2666-2736 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Surgery
Website: https://www.journals.elsevier.com/jtcvs-open

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