{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T19:00:53Z","timestamp":1780599653743,"version":"3.54.1"},"reference-count":33,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2024,11,9]],"date-time":"2024-11-09T00:00:00Z","timestamp":1731110400000},"content-version":"unspecified","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2024,10,21]]},"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To evaluate the impact of intraoperative neuromonitoring (IONM) on stroke and operative mortality after coronary and\/or valvular operations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was an observational study of coronary and\/or valvular heart operations from 2010 to 2021. Baseline characteristics and postoperative outcomes were compared by the use or non-use of IONM, which included both electroencephalography and somatosensory-evoked potentials. Propensity-score matching was employed to assess the association of IONM usage with operative mortality and stroke.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 19\u2009299 patients underwent a cardiac operation, of which 589 (3.1%) had IONM. Patients with IONM were more likely to have had baseline cerebrovascular disease (60% vs 22%). Patients with IONM had increased operative mortality (5.3% vs 2.5%) and stroke (4.9% vs 1.9%). Moreover, stroke and mortality were highly correlated, with 14% of strokes resulting in death, while only 2% of non-strokes resulted in death (p&lt;0.001). The unadjusted Kaplan-Meier survival estimate was significantly lower among the group with IONM (p&lt;0.001, log-rank). After propensity matching, however, there was no difference in operative mortality or stroke across each group: 3.6% vs 5.3% for mortality and 3.7% vs 5.4% for stroke. In the propensity-matched cohort, the Kaplan-Meier survival estimates were not significantly different across each group (p=0.419, log-rank).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Adjusting for baseline risk, there was no significant difference in adverse outcomes across each group. IONM may serve as a biomarker of cerebral ischaemia, and empirical adjustments based on changes may provide benefits for neurologic outcomes in high-risk patients. The efficacy of IONM during cardiac surgery should be prospectively validated.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2024-002939","type":"journal-article","created":{"date-parts":[[2024,11,9]],"date-time":"2024-11-09T09:25:14Z","timestamp":1731144314000},"page":"e002939","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Intraoperative neurophysiologic monitoring during cardiac surgery: an observational cohort study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2263-8318","authenticated-orcid":false,"given":"James","family":"Brown","sequence":"first","affiliation":[{"name":"UPMC, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nidhi","family":"Iyanna","sequence":"additional","affiliation":[{"name":"UPMC, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Yousef","sequence":"additional","affiliation":[{"name":"UPMC, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek","family":"Serna-Gallegos","sequence":"additional","affiliation":[{"name":"UPMC, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhui","family":"Zhu","sequence":"additional","affiliation":[{"name":"UPMC, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pyongsoo","family":"Yoon","sequence":"additional","affiliation":[{"name":"UPMC, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Kaczorowski","sequence":"additional","affiliation":[{"name":"UPMC, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Bonatti","sequence":"additional","affiliation":[{"name":"UPMC, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danny","family":"Chu","sequence":"additional","affiliation":[{"name":"UPMC, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Balzer","sequence":"additional","affiliation":[{"name":"Center for Clinical Neurophysiology, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathirvel","family":"Subramaniam","sequence":"additional","affiliation":[{"name":"UPMC, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parthasarathy D","family":"Thirumala","sequence":"additional","affiliation":[{"name":"Neurosurgery and Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Sultan","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA"},{"name":"University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,11,9]]},"reference":[{"key":"2025081612040371000_11.2.e002939.1","doi-asserted-by":"crossref","first-page":"3010","DOI":"10.1111\/jocs.14964","article-title":"Impact of stroke on outcomes following cardiac surgery: Propensity matched analysis","volume":"35","author":"Karunanantham","year":"2020","journal-title":"J Card Surg"},{"key":"2025081612040371000_11.2.e002939.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000885"},{"key":"2025081612040371000_11.2.e002939.3","doi-asserted-by":"crossref","first-page":"107057","DOI":"10.1016\/j.jstrokecerebrovasdis.2023.107057","article-title":"Postoperative stroke assessment inconsistencies in cardiac surgery: Contributors to higher stroke-related mortality?","volume":"32","author":"Riepen","year":"2023","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"2025081612040371000_11.2.e002939.4","doi-asserted-by":"crossref","first-page":"77","DOI":"10.15420\/icr.2011.9.2.77","article-title":"Risks of Stroke After Coronary Artery Bypass Graft - 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