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Thromboembolic complications after surgical correction of mitral regurgitation incidence, predictors, and clinical

Antonio Russo1, Francesco Grigioni, Jean-François Avierinos

  • 1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.

Journal of the American College of Cardiology
|March 22, 2008
PubMed
Abstract

Insights

Thromboembolic risk, particularly ischemic stroke (IS), after mitral regurgitation (MR) surgery is high early but decreases long-term. Mitral valve repair (MRep) offers the lowest long-term IS and bleeding risks compared to valve replacements.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Thromboembolic Disease

Background:

  • Guidelines recommend mitral regurgitation (MR) surgery for asymptomatic patients.
  • Thromboembolic risks, specifically ischemic stroke (IS), post-MR surgery are not well-defined.

Purpose of the Study:

  • To determine the thromboembolic risk, focusing on IS, following MR surgery.
  • To compare IS risk after different surgical procedures (mitral valve repair [MRep] vs. mechanical [MVRm] and biological [MVRb] mitral valve replacement) with the general population.

Main Methods:

  • A cohort of 1,344 patients undergoing MR surgery (MRep, MVRm, MVRb) was analyzed.
  • Thromboembolic complications, particularly IS diagnosed by neurologists, were assessed at early (<30 days), midterm (30-180 days), and long-term (>180 days) follow-up intervals.
  • IS risk was compared to population-expected rates.

Main Results:

  • Ischemic stroke occurred in 130 patients, with cumulative rates at 5 years of 6.1% (MRep), 8% (MVRb), and 16.1% (MVRm).
  • Early IS risk (<30 days) was significantly elevated across all procedures compared to the general population (Risk Ratio 41).
  • Long-term IS risk (>180 days) was similar to the general population for MRep (Relative Risk 1.2) and MVRb (0.98), but remained high for MVRm (4.8).
  • Bleeding risk at 10 years was lowest following MRep (7%) compared to MVRb (14%) and MVRm (16%).

Conclusions:

  • Thromboembolic complications post-MR surgery warrant attention, especially in the early period.
  • Long-term IS risk is comparable to the general population after MRep and MVRb, but not MVRm.
  • Mitral valve repair (MRep) is associated with lower long-term thromboembolic and bleeding risks, supporting its preference.
  • Further trials are needed to mitigate thromboembolic and bleeding risks after MR surgery.

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