Evidence map›Paper›PMID 35483981›Full record

Trial reportThe Journal of thoracic and cardiovascular surgery2024

The impact of perioperative stroke and delirium on outcomes after surgical aortic valve replacement.

Steven R Messé, Jessica R Overbey, Vinod H Thourani, Alan J Moskowitz, Annetine C Gelijns, Mark A Groh, Michael J Mack, Gorav Ailawadi, Karen L Furie, Andrew M Southerland and 17 more

Open access · greenAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The Journal of thoracic and cardiovascular surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.7field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 11 citations in OpenAlex.

  1. Article
  2. Article
  3. Neurocognitive decline in cardiac surgery patients: What do we know?The Journal of thoracic and cardiovascular surgery · 2023
    Article
  4. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

27 authors at 20 institutions in 2 countries.

Steven R MesséDepartment of Stroke and Neurocritical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pa.
Jessica R OverbeyInternational Center for Health Outcomes and Innovation Research (InCHOIR), The Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
Vinod H ThouraniMarcus Valve Center, Department of Cardiovascular Surgery, Piedmont Heart Institute, Atlanta, Ga.
Alan J MoskowitzInternational Center for Health Outcomes and Innovation Research (InCHOIR), The Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
Annetine C GelijnsInternational Center for Health Outcomes and Innovation Research (InCHOIR), The Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: Annetine.gelijns@mssm.edu.
Mark A GrohAsheville Heart, Mission Health and Hospitals, Asheville, NC.
Michael J MackCardiovascular Surgery, Baylor Scott & White Health, Plano, Tex.
Gorav AilawadiDepartments of Cardiac Surgery and Surgery, University of Michigan Health System, Ann Arbor, Mich.
Karen L FurieDepartment of Neurology, Alpert Medical School of Brown University, Providence, RI.
Andrew M SoutherlandDivision of Vascular Neurology, University of Virginia Health System, Charlottesville, Va.
Michael L JamesDepartment of Anesthesiology, Duke University Medical Center, Durham, NC; Department of Neurology, Duke University Medical Center, Durham, NC.
Claudia Scala MoyDivision of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md.
Lopa GuptaInternational Center for Health Outcomes and Innovation Research (InCHOIR), The Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
Pierre VoisineDepartment of Surgery, Institut de Cardiologie et Pneumologie de Québec, Québec, Canada.
Louis P PerraultDepartment of Surgery, Montreal Heart Institute, Québec, Canada.
Michael E BowdishSurgery and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
A Marc GillinovDepartment of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
Patrick T O'GaraCardiovascular Division, Brigham and Women's Hospital, Boston, Mass.
Maral OuzounianDivision of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, UHN-Toronto General Hospital, Toronto, Ontario, Canada.
Bryan A WhitsonDivision of Cardiac Surgery, Department of Surgery, The Ohio State University, Columbus, Ohio.
John C MullenDivision of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada.
Marissa A MillerDivision of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
James S GammieDepartment of Cardiac Surgery, Johns Hopkins Heart and Vascular Institute, Baltimore, Md.
Stephanie PanInternational Center for Health Outcomes and Innovation Research (InCHOIR), The Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
Guray ErusDepartment of Radiology, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pa.
Jeffrey N BrowndykeDepartment of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC.
Cardiothoracic Surgical Trials Network (CTSN) Investigators
Icahn School of Medicine at Mount Sinai · USUniversity of Pennsylvania · USBaylor Scott & White Health · USBrigham and Women's Hospital · USBrown University · USCleveland Clinic · USDuke Medical Center · USInstitut Universitaire de Cardiologie et de Pneumologie de Québec · CAMichigan Medicine · USMontreal Heart Institute · CANational Institutes of Health · USThe Ohio State University · USUniversity of Alberta · CAUniversity of Southern California · USValve (United States) · USDuke University Hospital · USMission Health · USMission Hospital · USNational Heart Lung and Blood Institute · USNational Institute of Neurological Disorders and Stroke · US

Funding

REVISED CAROL ACT IIU01HL088942 · NHLBI · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · PI GELIJNS, ANNE CHRISTINE, MOSKOWITZ, ALAN J · 2007 to 2025
$122.6M
NHLBI NIH HHS U01 HL088942
6 · The paper itself

Abstract

objectiveThe effects of stroke and delirium on postdischarge cognition and patient-centered health outcomes after surgical aortic valve replacement (SAVR) are not well characterized. Here, we assess the impact of postoperative stroke and delirium on these health outcomes in SAVR patients at 90 days.

methodsPatients (N = 383) undergoing SAVR (41% received concomitant coronary artery bypass graft) enrolled in a randomized trial of embolic protection devices underwent serial neurologic and delirium evaluations at postoperative days 1, 3, and 7 and magnetic resonance imaging at day 7. Outcomes included 90-day functional status, neurocognitive decline from presurgical baseline, and quality of life.

resultsBy postoperative day 7, 25 (6.6%) patients experienced clinical stroke and 103 (28.5%) manifested delirium. During index hospitalization, time to discharge was longer in patients experiencing stroke (hazard ratio, 0.62; 95% confidence interval [CI], 0.42-0.94; P = .02) and patients experiencing delirium (hazard ratio, 0.68; 95% CI, 0.54-0.86; P = .001). At day 90, patients experiencing stroke were more likely to have a modified Rankin score >2 (odds ratio [OR], 5.9; 95% CI, 1.7-20.1; P = .01), depression (OR, 5.3; 95% CI, 1.6-17.3; P = .006), a lower 12-Item Short Form Survey physical health score (adjusted mean difference -3.3 ± 1.9; P = .08), and neurocognitive decline (OR, 7.8; 95% CI, 2.3-26.4; P = .001). Delirium was associated with depression (OR, 2.2; 95% CI, 0.9-5.3; P = .08), lower 12-Item Short Form Survey physical health (adjusted mean difference -2.3 ± 1.1; P = .03), and neurocognitive decline (OR, 2.2; 95% CI, 1.2-4.0; P = .01).

conclusionsStroke and delirium occur more frequently after SAVR than is commonly recognized, and these events are associated with disability, depression, cognitive decline, and poorer quality of life at 90 days postoperatively. These findings support the need for new interventions to reduce these events and improve patient-centered outcomes.

Indexed as

Aortic Valve StenosisDeliriumHeart Valve Prosthesis ImplantationStrokeTranscatheter Aortic Valve ReplacementAftercareAortic ValveHumansPatient DischargeQuality of LifeRisk FactorsTreatment Outcomeaortic valvedeliriumneurological outcomesperioperative managementsurgical aortic valve replacement (SAVR)

Identifiers

PMID35483981
PMCPMC9996687
OpenAlexW4221070086

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.