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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
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Late incidence and determinants of stroke after aortic and mitral valve replacement

Marc Ruel1, Roy G Masters, Fraser D Rubens

  • 1Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada. mruel@ottawaheart.ca

The Annals of Thoracic Surgery
|June 30, 2004
PubMed

Insights

Patients with prosthetic valves face a significant risk of embolic stroke, with approximately 20% experiencing one within 15 years. Modifiable factors like avoiding smoking and timely mitral valve surgery can reduce this risk.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Clinical Epidemiology

Background:

  • Stroke is a serious complication for patients with prosthetic heart valves.
  • Characterizing the long-term occurrence of stroke in this population from a large cohort is needed.

Purpose of the Study:

  • To investigate the incidence and risk factors of late stroke in patients following left-heart valve replacement.

Main Methods:

  • A prospective study followed 3,189 adult patients (3,576 valve replacement operations) for 20,096 patient-years.
  • Bootstrapped survival analysis identified patient and valve-related factors influencing stroke incidence.

Main Results:

  • Embolic strokes occurred at rates of 1.3-2.3% per year, with mitral mechanical valves having the highest incidence (2.3% +/- 0.4%).
  • Independent risk factors included age >75, female gender, smoking, atrial fibrillation, coronary disease, and preoperative left ventricular dysfunction for mitral prostheses.
  • Warfarin combined with aspirin or dipyridamole did not significantly reduce stroke risk in mechanical prosthesis recipients.

Conclusions:

  • About 20% of patients with prosthetic valves experience an embolic stroke within 15 years post-replacement.
  • Potentially modifiable risk factors include smoking cessation, choice of mitral mechanical prostheses, aortic tilting-disc valves, and timely mitral surgery before left ventricular dysfunction onset.
Abstract

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