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. 2022 Feb 24:10:87-96.
doi: 10.1016/j.xjon.2022.02.026. eCollection 2022 Jun.

Silent cerebral ischemia detected by magnetic resonance imaging can predict postoperative delirium after total arch replacement for aneurysm

Keisuke Shibagaki  1 , Tomonori Shirasaka  1 , Jun Sawada  2 , Yasuaki Saijo  3 , Shingo Kunioka  1 , Yuta Kikuchi  1 , Hiroyuki Kamiya  1
Affiliations

Silent cerebral ischemia detected by magnetic resonance imaging can predict postoperative delirium after total arch replacement for aneurysm

Keisuke Shibagaki et al. JTCVS Open. .

Abstract

Objective: To identify whether preoperative magnetic resonance imaging findings of the brain can predict postoperative delirium in patients who undergo arch replacement for aneurysms.

Methods: Overall, 193 patients who underwent aortic replacement for the first time at a single institution between April 2014 and September 2020 were enrolled in this retrospective study. After we excluded patients with acute aortic dissection, no preoperative magnetic resonance imaging findings of the brain, and postoperative cerebral infarction, 50 patients were included and divided into 2 groups, according to their confusion scale results: postoperative delirium (group D) and nonpostoperative delirium (group ND). Preoperative magnetic resonance imaging findings of the brain were classified into lacunar stroke, periventricular hyperintensity, and deep subcortical white matter hyperintensity groups; the latter 2 groups were further classified based on the Fazekas scale, grade 0 to 3.

Results: There were 23 patients (46%) in group D and 27 (54%) in group ND. The mean age was significantly greater in group D than in group ND (75 vs 70 years; P = .007). The mean operative time was significantly longer in group D than in group ND (447 vs 384 minutes; P = .024). As for preoperative magnetic resonance imaging findings of the brain, there were significantly more lacunar stroke cases in group D than in group ND (P = .027). In multivariable logistic regression with stepwise selection, high-grade periventricular hyperintensity was significantly related to postoperative delirium (odds ratio, 9.38; 95% confidence interval, 1.55-56.56; P = .015).

Conclusions: Silent cerebral ischemia detected by preoperative magnetic resonance imaging of the brain was a significant risk factor for postoperative delirium.

Keywords: AAA, aortic arch aneurysm; AR, arch replacement; CI, confidence interval; DSWMH, deep subcortical white matter hyperintensities; ICDSC, Intensive Care Delirium Screening Checklist; ICU, intensive care unit; MRI, magnetic resonance imaging; NCS, Neelon and Champagne confusion scale; NPD, nonpostoperative delirium; OR, odds ratio; PD, postoperative delirium; PVH, periventricular hyperintensity; SCP, selective cerebral perfusion; TAR, total arch replacement; TEVAR, thoracic endovascular aortic repair; WMH, white matter hyperintensity; magnetic resonance imaging; postoperative delirium; total arch replacement; white matter intensity.

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Figures

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Graphical abstract
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Relationship between preoperative brain MRI findings and postoperative delirium.
Figure 1
Figure 1
Flow chart of patient enrollment. TAR, Total arch replacement; HAR, hemiarch replacement; TA, thoracic aneurysm; MRI, magnetic resonance imaging; D, postoperative delirium group; ND, nonpostoperative delirium group.
Figure 2
Figure 2
Examples of magnetic resonance imaging of the brain representing the Fazekas scale. Periventricular hyperintensity (A) and deep subcortical white matter hyperintensity (B) are classified into the 4 groups. PVH, Periventricular hyperintensity.
Figure 3
Figure 3
The proportion of brain magnetic resonance imaging findings in groups D and ND. There were significantly more lacunar infarcts (A), high-grade PVH (B), and high-grade DSWMH (C) in group D than in group ND. D, Postoperative delirium group; ND, nonpostoperative delirium group; PVH, periventricular hyperintensity; DSWMH, deep subcortical white matter hyperintensity.
Figure 4
Figure 4
Summary of this study. We analyzed whether preoperative MRI findings of the brain can predict postoperative delirium in patients undergoing total arch replacement for aneurysms. MRI, Magnetic resonance imaging; D, postoperative delirium group; ND, nonpostoperative delirium group; NEECHAM, Neelon and Champagne; ICDSC, Intensive Care Delirium Screening Checklist; PVH, periventricular hyperintensity; DSWMH, deep subcortical white matter hyperintensity; PD, postoperative delirium.
Figure 5
Figure 5
The relationship between the Fazekas scale of PVH and the length of PD in group D (n = 23). There was no significant correlation between PVH grade and the length of PD (rs = 0.065, n = 23, P = .767). PVH, Periventricular hyperintensity; PD, postoperative delirium; D, postoperative delirium group.
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