Infarct‐related structural disconnection and delirium in surgical aortic valve replacement patients
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 “silent” infarcts and in‐hospital 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> = 298; 39% female, 7% non‐White, 74 ± 7 years). Delirium during in‐hospital recovery was serially screened using the Confusion Assessment Method. Parcellation and tractography atlas‐based neuroimaging methods were used to determine infarct locations and cortical connectivity effects. Mixed‐effect, zero‐inflated gaussian modeling analyses, accounting for brain region‐specific 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‐related structural disconnection (DWI‐ISD) was observed in frontal and temporal lobe regions (<jats:italic>p</jats:italic>‐FDR < 0.05). Fewer brain regions demonstrated DWI‐ISD loss in the suction‐based neuroprotection device group, relative to filtration‐based 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 “silent” as commonly assumed.</jats:p></jats:sec>
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Browndyke, Jeffrey N, Lewis E Tomalin, Guray Erus, Jessica R Overbey, Amy Kuceyeski, Alan J Moskowitz, Emilia Bagiella, Alexander Iribarne, et al. (n.d.). Infarct‐related structural disconnection and delirium in surgical aortic valve replacement patients. Annals of Clinical and Translational Neurology. 10.1002/acn3.51949 Retrieved from https://hdl.handle.net/10161/29562.
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Jeffrey Nicholas Browndyke
Dr. Browndyke is an Associate Professor of Behavioral Health & Neurosciences in the Department of Psychiatry & Behavioral Sciences. He has a secondary appointment as Assistant Professor of Cardiovascular & Thoracic Surgery.
Dr. Browndyke's research interests involve the use of advanced neurocognitive and neuroimaging techniques for perioperative contributions to delirium and later dementia risk, monitoring of late-life neuropathological disease progression, and intervention/treatment outcomes. His research also involves novel telehealth methods for remote neurocognitive evaluation and implementation of non-invasive neuromodulatory techniques to assist in postoperative recovery and dementia risk reduction.
Dr. Browndyke's clinical expertise is focused upon geriatric neuropsychology with an emphasis in the assessment, diagnosis, and treatment of dementia and related disorders in adults and US veteran patient populations.

Joseph P. Mathew
Current research interests include:
1. The relationship between white matter patency, functional connectivity (fMRI) and neurocognitive function following cardiac surgery.
2. The relationship between global and regional cortical beta-amyloid deposition and postoperative cognitive decline.
3. The effect of lidocaine infusion upon neurocognitive function following cardiac surgery.
4. The association between genotype and outcome after cardiac surgery.
5. Atrial fibrillation following cardiopulmonary bypass.
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