Risk factors and prognosis of adult-onset post-pump chorea

• Published in: Journal of the neurological sciences Vol. 422; p. 117328
• Main Authors: Ahn, Jong Hyeon, Song, Joomee, Choi, Inyoung, Youn, Jinyoung, Cho, Jin Whan
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.03.2021
• Subjects: Adult; Cardiopulmonary Bypass - adverse effects; Cardiopulmonary bypass surgery; Chorea; Chorea - diagnostic imaging; Chorea - epidemiology; Chorea - etiology; Female; Humans; Male; Middle Aged; Multicenter Studies as Topic; Post-pump chorea; Prognosis; Pulmonary embolism; Risk Factors; Pulmonary embolism; Post-pump chorea; Cardiopulmonary bypass surgery; Chorea
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2021.117328

Post-pump chorea (PPC), defined as the development of chorea after major cardiac surgery utilizing cardiopulmonary bypass (CPB), has been rarely reported in adults. We compared 17 patients with adult-onset PPC to controls who did not develop chorea after cardiac surgery with CPB. Two patients were enrolled using hospital based data and 15 were collected by a systematic literature review. The controls without chorea after CPB (n = 4208) were collected using hospital based data. We described the clinical and surgical features of adult-onset PPC and compared them with those of the controls. Ten of 17 PPC patients were male, the mean age was 46.8 years, and the mean onset latency was 6.0 days. The adult-onset PPC patients were younger (46.8 ± 16.7 vs. 59.1 ± 15.0, p = 0.001), had a lower minimum body temperature (23.3 ± 5.5 vs. 29.7 ± 3.7, p < 0.001) and a longer total circulatory arrest time (63.7 ± 7.5 vs. 21.0 ± 14.6, p < 0.001) than controls. Forty-three percentage of patients with adult-onset PPC had persistent chorea on follow-up, and these patients showed a higher rate of abnormal initial brain MRI compared with the patients with good clinical outcomes (p = 0.041). The onset age, onset latency, underlying disease, treatment response, and surgical features were variable among PPC patients, while abnormal initial brain MRI was associated with persistent chorea. Pooling more cases through multicenter efforts will hopefully provide more knowledge on the underlying pathophysiology, prevention, and management of PPC. •Post-pump chorea (PPC) is extremely rare in adults and poorly understood.•Adult onset PPC had different clinical and surgical feature compared to controls.•Initial abnormal brain MRI can predict poor clinical outcome of adult onset PPC.