{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T06:32:31Z","timestamp":1792305151802,"version":"4.4.0"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[1999,3]]},"abstract":"<jats:p>\n            <jats:italic>Background and Purpose<\/jats:italic>\n            \u2014Cerebral injury after cardiac surgery is now recognized as a serious and costly healthcare problem mandating immediate attention. To effect solution, those subgroups of patients at greatest risk must be identified, thereby allowing efficient implementation of new clinical strategies. No such subgroup has been identified; however, patients undergoing intracardiac surgery are thought to be at high risk, but comprehensive data regarding specific risk, impact on cost, and discharge disposition are not available.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Methods<\/jats:italic>\n            \u2014We prospectively studied 273 patients enrolled from 24 diverse US medical centers, who were undergoing intracardiac and coronary artery surgery. Patient data were collected using standardized methods and included clinical, historical, specialized testing, neurological outcome and autopsy data, and measures of resource utilization. Adverse outcomes were defined a priori and determined after database closure by a blinded independent panel. Stepwise logistic regression models were developed to estimate the relative risks associated with clinical history and intraoperative and postoperative events.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Results<\/jats:italic>\n            \u2014Adverse cerebral outcomes occurred in 16% of patients (43\/273), being nearly equally divided between type I outcomes (8.4%; 5 cerebral deaths, 16 nonfatal strokes, and 2 new TIAs) and type II outcomes (7.3%; 17 new intellectual deterioration persisting at hospital discharge and 3 newly diagnosed seizures). Associated resource utilization was significantly increased\u2014prolonging median intensive care unit stay from 3 days (no adverse cerebral outcome) to 8 days (type I;\n            <jats:italic>P<\/jats:italic>\n            &lt;0.001) and from 3 to 6 days (type II;\n            <jats:italic>P<\/jats:italic>\n            &lt;0.001), and increasing hospitalization by 50% (type II,\n            <jats:italic>P<\/jats:italic>\n            =0.04) to 100% (type I,\n            <jats:italic>P<\/jats:italic>\n            &lt;0.001). Furthermore, specialized care after hospital discharge was frequently necessary in those with type I outcomes, in that only 31% returned home compared with 85% of patients without cerebral complications (\n            <jats:italic>P<\/jats:italic>\n            &lt;0.001). Significant risk factors for type I outcomes related primarily to embolic phenomena, including proximal aortic atherosclerosis, intracardiac thrombus, and intermittent clamping of the aorta during surgery. For type II outcomes, risk factors again included proximal aortic atherosclerosis, as well as a preoperative history of endocarditis, alcohol abuse, perioperative dysrhythmia or poorly controlled hypertension, and the development of a low-output state after cardiopulmonary bypass.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions<\/jats:italic>\n            \u2014These prospective multicenter findings demonstrate that patients undergoing intracardiac surgery combined with coronary revascularization are at formidable risk, in that 1 in 6 will develop cerebral complications that are frequently costly and devastating. Thus, new strategies for perioperative management\u2014including technical and pharmacological interventions\u2014are now mandated for this subgroup of cardiac surgery patients.\n          <\/jats:p>","DOI":"10.1161\/01.str.30.3.514","type":"journal-article","created":{"date-parts":[[2011,6,17]],"date-time":"2011-06-17T20:08:03Z","timestamp":1308341283000},"page":"514-522","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":194,"title":["Cerebral Injury After Cardiac Surgery"],"prefix":"10.1161","volume":"30","author":[{"given":"Richard L.","family":"Wolman","sequence":"first","affiliation":[{"name":"From the Departments of Anesthesiology, Neurology, Surgery and Cardiology at the School of Medicine, Medical College of Virginia Campus, Richmond (R.L.W.); the Texas Heart Institute, Houston, Tex (N.A.N.); Veterans Administration Medical Center, Milwaukee, Wisc (A.A.); New York University, NY (M.S.K., K.E.M.); Kaiser Permanente Medical Center, San Francisco, Calif (G.W.R.); Duke Heart Center, Durham, NC (M.F.N.); Stanford University, Stanford, Calif (C.M.M.); the University of Pittsburgh, Pittsburgh..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy A.","family":"Nussmeier","sequence":"additional","affiliation":[{"name":"From the Departments of Anesthesiology, Neurology, Surgery and Cardiology at the School of Medicine, Medical College of Virginia Campus, Richmond (R.L.W.); the Texas Heart Institute, Houston, Tex (N.A.N.); Veterans Administration Medical Center, Milwaukee, Wisc (A.A.); New York University, NY (M.S.K., K.E.M.); Kaiser Permanente Medical Center, San Francisco, Calif (G.W.R.); Duke Heart Center, Durham, NC (M.F.N.); Stanford University, Stanford, Calif (C.M.M.); the University of Pittsburgh, Pittsburgh..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil","family":"Aggarwal","sequence":"additional","affiliation":[{"name":"From the Departments of Anesthesiology, Neurology, Surgery and Cardiology at the School of Medicine, Medical College of Virginia Campus, Richmond (R.L.W.); the Texas Heart Institute, Houston, Tex (N.A.N.); Veterans Administration Medical Center, Milwaukee, Wisc (A.A.); New York University, NY (M.S.K., K.E.M.); Kaiser Permanente Medical Center, San Francisco, Calif (G.W.R.); Duke Heart Center, Durham, NC (M.F.N.); Stanford University, Stanford, Calif (C.M.M.); the University of Pittsburgh, Pittsburgh..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc S.","family":"Kanchuger","sequence":"additional","affiliation":[{"name":"From the Departments of Anesthesiology, Neurology, Surgery and Cardiology at the School of Medicine, Medical College of Virginia Campus, Richmond (R.L.W.); the Texas Heart Institute, Houston, Tex (N.A.N.); Veterans Administration Medical Center, Milwaukee, Wisc (A.A.); New York University, NY (M.S.K., K.E.M.); Kaiser Permanente Medical Center, San Francisco, Calif (G.W.R.); Duke Heart Center, Durham, NC (M.F.N.); Stanford University, Stanford, Calif (C.M.M.); the University of Pittsburgh, Pittsburgh..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary W.","family":"Roach","sequence":"additional","affiliation":[{"name":"From the Departments of Anesthesiology, Neurology, Surgery and Cardiology at the School of Medicine, Medical College of Virginia Campus, Richmond (R.L.W.); the Texas Heart Institute, Houston, Tex (N.A.N.); Veterans Administration Medical Center, Milwaukee, Wisc (A.A.); New York University, NY (M.S.K., K.E.M.); Kaiser Permanente Medical Center, San Francisco, Calif (G.W.R.); Duke Heart Center, Durham, NC (M.F.N.); Stanford University, Stanford, Calif (C.M.M.); the University of Pittsburgh, Pittsburgh..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark F.","family":"Newman","sequence":"additional","affiliation":[{"name":"From the Departments of Anesthesiology, Neurology, Surgery and Cardiology at the School of Medicine, Medical College of Virginia Campus, Richmond (R.L.W.); the Texas Heart Institute, Houston, Tex (N.A.N.); Veterans Administration Medical Center, Milwaukee, Wisc (A.A.); New York University, NY (M.S.K., K.E.M.); Kaiser Permanente Medical Center, San Francisco, Calif (G.W.R.); Duke Heart Center, Durham, NC (M.F.N.); Stanford University, Stanford, Calif (C.M.M.); the University of Pittsburgh, Pittsburgh..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina Mora","family":"Mangano","sequence":"additional","affiliation":[{"name":"From the Departments of Anesthesiology, Neurology, Surgery and Cardiology at the School of Medicine, Medical College of Virginia Campus, Richmond (R.L.W.); the Texas Heart Institute, Houston, Tex (N.A.N.); Veterans Administration Medical Center, Milwaukee, Wisc (A.A.); New York University, NY (M.S.K., K.E.M.); Kaiser Permanente Medical Center, San Francisco, Calif (G.W.R.); Duke Heart Center, Durham, NC (M.F.N.); Stanford University, Stanford, Calif (C.M.M.); the University of Pittsburgh, Pittsburgh..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine E.","family":"Marschall","sequence":"additional","affiliation":[{"name":"From the Departments of Anesthesiology, Neurology, Surgery and Cardiology at the School of Medicine, Medical College of Virginia Campus, Richmond (R.L.W.); the Texas Heart Institute, Houston, Tex (N.A.N.); Veterans Administration Medical Center, Milwaukee, Wisc (A.A.); New York University, NY (M.S.K., K.E.M.); Kaiser Permanente Medical Center, San Francisco, Calif (G.W.R.); Duke Heart Center, Durham, NC (M.F.N.); Stanford University, Stanford, Calif (C.M.M.); the University of Pittsburgh, Pittsburgh..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Ley","sequence":"additional","affiliation":[{"name":"From the Departments of Anesthesiology, Neurology, Surgery and Cardiology at the School of Medicine, Medical College of Virginia Campus, Richmond (R.L.W.); the Texas Heart Institute, Houston, Tex (N.A.N.); Veterans Administration Medical Center, Milwaukee, Wisc (A.A.); New York University, NY (M.S.K., K.E.M.); Kaiser Permanente Medical Center, San Francisco, Calif (G.W.R.); Duke Heart Center, Durham, NC (M.F.N.); Stanford University, Stanford, Calif (C.M.M.); the University of Pittsburgh, Pittsburgh..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis M.","family":"Boisvert","sequence":"additional","affiliation":[{"name":"From the Departments of Anesthesiology, Neurology, Surgery and Cardiology at the School of Medicine, Medical College of Virginia Campus, Richmond (R.L.W.); the Texas Heart Institute, Houston, Tex (N.A.N.); Veterans Administration Medical Center, Milwaukee, Wisc (A.A.); New York University, NY (M.S.K., K.E.M.); Kaiser Permanente Medical Center, San Francisco, Calif (G.W.R.); Duke Heart Center, Durham, NC (M.F.N.); Stanford University, Stanford, Calif (C.M.M.); the University of Pittsburgh, Pittsburgh..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard M.","family":"Ozanne","sequence":"additional","affiliation":[{"name":"From the Departments of Anesthesiology, Neurology, Surgery and Cardiology at the School of Medicine, Medical College of Virginia Campus, Richmond (R.L.W.); the Texas Heart Institute, Houston, Tex (N.A.N.); Veterans Administration Medical Center, Milwaukee, Wisc (A.A.); New York University, NY (M.S.K., K.E.M.); Kaiser Permanente Medical Center, San Francisco, Calif (G.W.R.); Duke Heart Center, Durham, NC (M.F.N.); Stanford University, Stanford, Calif (C.M.M.); the University of Pittsburgh, Pittsburgh..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahvie","family":"Herskowitz","sequence":"additional","affiliation":[{"name":"From the Departments of Anesthesiology, Neurology, Surgery and Cardiology at the School of Medicine, Medical College of Virginia Campus, Richmond (R.L.W.); the Texas Heart Institute, Houston, Tex (N.A.N.); Veterans Administration Medical Center, Milwaukee, Wisc (A.A.); New York University, NY (M.S.K., K.E.M.); Kaiser Permanente Medical Center, San Francisco, Calif (G.W.R.); Duke Heart Center, Durham, NC (M.F.N.); Stanford University, Stanford, Calif (C.M.M.); the University of Pittsburgh, Pittsburgh..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven H.","family":"Graham","sequence":"additional","affiliation":[{"name":"From the Departments of Anesthesiology, Neurology, Surgery and Cardiology at the School of Medicine, Medical College of Virginia Campus, Richmond (R.L.W.); the Texas Heart Institute, Houston, Tex (N.A.N.); Veterans Administration Medical Center, Milwaukee, Wisc (A.A.); New York University, NY (M.S.K., K.E.M.); Kaiser Permanente Medical Center, San Francisco, Calif (G.W.R.); Duke Heart Center, Durham, NC (M.F.N.); Stanford University, Stanford, Calif (C.M.M.); the University of Pittsburgh, Pittsburgh..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis T.","family":"Mangano","sequence":"additional","affiliation":[{"name":"From the Departments of Anesthesiology, Neurology, Surgery and Cardiology at the School of Medicine, Medical College of Virginia Campus, Richmond (R.L.W.); the Texas Heart Institute, Houston, Tex (N.A.N.); Veterans Administration Medical Center, Milwaukee, Wisc (A.A.); New York University, NY (M.S.K., K.E.M.); Kaiser Permanente Medical Center, San Francisco, Calif (G.W.R.); Duke Heart Center, Durham, NC (M.F.N.); Stanford University, Stanford, Calif (C.M.M.); the University of Pittsburgh, Pittsburgh..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199612193352501"},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/088506669701200305"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-198211000-00003"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/str.14.5.6606871"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)33878-4"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02470862"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/0003-4975(94)00672-T"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/096721099300100220"},{"key":"e_1_3_2_9_2","first-page":"1796","volume":"59","year":"1995","unstructured":"Mills SA. Risk factors for cerebral injury and cardiac surgery. Ann Thorac Surg. 1995;59:1796\u20131799.","journal-title":"Ann Thorac Surg"},{"key":"e_1_3_2_10_2","first-page":"103","volume":"10","year":"1981","unstructured":"Breuer AC, Franco I, Marzewski D, Soto-Velasco J. Left ventricular thrombi seen by ventriculography are a significant risk factor for stroke in open-heart surgery. 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