{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T21:02:16Z","timestamp":1792616536599,"version":"4.5.0"},"reference-count":50,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,12,28]],"date-time":"2023-12-28T00:00:00Z","timestamp":1703721600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01\u2010HL130443"],"award-info":[{"award-number":["R01\u2010HL130443"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["U01\u2010HL088942"],"award-info":[{"award-number":["U01\u2010HL088942"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01\u2010AG074185"],"award-info":[{"award-number":["R01\u2010AG074185"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Transl Neurol"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Although acute brain infarcts are common after surgical aortic valve replacement (SAVR), they are often unassociated with clinical stroke symptoms. The relationship between clinically \u201csilent\u201d infarcts and in\u2010hospital delirium remains uncertain; obscured, in part, by how infarcts have been traditionally summarized as global metrics, independent of location or structural consequence. We sought to determine if infarct location and related structural connectivity changes were associated with postoperative delirium after SAVR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A secondary analysis of a randomized multicenter SAVR trial of embolic protection devices (NCT02389894) was conducted, excluding participants with clinical stroke or incomplete neuroimaging (<jats:italic>N<\/jats:italic>\u2009=\u2009298; 39% female, 7% non\u2010White, 74\u2009\u00b1\u20097\u2009years). Delirium during in\u2010hospital recovery was serially screened using the Confusion Assessment Method. Parcellation and tractography atlas\u2010based neuroimaging methods were used to determine infarct locations and cortical connectivity effects. Mixed\u2010effect, zero\u2010inflated gaussian modeling analyses, accounting for brain region\u2010specific infarct characteristics, were conducted to examine for differences within and between groups by delirium status and perioperative neuroprotection device strategy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>23.5% participants experienced postoperative delirium. Delirium was associated with significantly increased lesion volumes in the right cerebellum and temporal lobe white matter, while diffusion weighted imaging infarct\u2010related structural disconnection (DWI\u2010ISD) was observed in frontal and temporal lobe regions (<jats:italic>p<\/jats:italic>\u2010FDR\u2009&lt;\u20090.05). Fewer brain regions demonstrated DWI\u2010ISD loss in the suction\u2010based neuroprotection device group, relative to filtration\u2010based device or standard aortic cannula.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Structural disconnection from acute infarcts was greater in patients who experienced postoperative delirium, suggesting that the impact from covert perioperative infarcts may not be as clinically \u201csilent\u201d as commonly assumed.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acn3.51949","type":"journal-article","created":{"date-parts":[[2023,12,29]],"date-time":"2023-12-29T06:10:22Z","timestamp":1703830222000},"page":"263-277","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Infarct\u2010related structural disconnection and delirium in surgical aortic valve replacement patients"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8573-7073","authenticated-orcid":false,"given":"Jeffrey N.","family":"Browndyke","sequence":"first","affiliation":[{"name":"Division of Behavioral Medicine and Neurosciences, Department of Psychiatry and Behavioral Sciences Duke University Medical Center  Durham North Carolina USA"},{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4545-7138","authenticated-orcid":false,"given":"Lewis E.","family":"Tomalin","sequence":"additional","affiliation":[{"name":"Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guray","family":"Erus","sequence":"additional","affiliation":[{"name":"Department of Radiology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica R.","family":"Overbey","sequence":"additional","affiliation":[{"name":"Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Kuceyeski","sequence":"additional","affiliation":[{"name":"Department of Radiology Weill Cornell Medical College  New York New York USA"},{"name":"Brain and Mind Research Institute Weill Cornell Medical College  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan J.","family":"Moskowitz","sequence":"additional","affiliation":[{"name":"Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Bagiella","sequence":"additional","affiliation":[{"name":"Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Iribarne","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery Staten Island University Hospital, Northwell Health Staten Island  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Acker","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, Department of Surgery University of Pennsylvania School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Mack","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery Baylor Research 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