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Perioperative Strokes and Early Outcomes in Mitral Valve Surgery: A Nationwide Analysis

Reshmi Udesh1, Amol Mehta2, Thomas G Gleason1

  • 1Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA.

Journal of Cardiothoracic and Vascular Anesthesia
|March 6, 2017
PubMed

Insights

Perioperative stroke is a major risk factor for death and complications after mitral valve surgery. Identifying and preventing strokes can improve patient outcomes in this high-risk population.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Public Health

Background:

  • Mitral valve surgery is a critical intervention for severe mitral valve disease.
  • Understanding perioperative complications is essential for improving patient outcomes.
  • Trends in surgical outcomes and risk factors require ongoing investigation.

Purpose of the Study:

  • To establish perioperative stroke as an independent risk factor for in-hospital morbidity and mortality following mitral valve surgery.
  • To analyze trends in early outcomes of mitral valve surgery over the past decade.

Main Methods:

  • Utilized the National Inpatient Sample database (1999-2011) for analysis.
  • Identified patients undergoing isolated mitral valve repair or replacement using ICD-9 codes.
  • Performed univariate and multivariate analyses to determine risk factors for in-hospital mortality and morbidity.

Main Results:

  • The study included 21,821 patients, with an in-hospital mortality of 5.5% and morbidity of 63.3%.
  • Perioperative stroke occurred in 3.89% of patients and was the strongest predictor of mortality (OR 2.34) and morbidity (OR 4.53).
  • Significant predictors of adverse outcomes included age, emergency surgery, comorbidities (hypertension, renal failure), and postoperative complications (cardiac arrest, myocardial infarction).

Conclusions:

  • Perioperative stroke is a critical independent risk factor for adverse outcomes after mitral valve surgery.
  • While mortality decreased over the decade, morbidity increased, highlighting the need for improved perioperative management.
  • Preoperative risk stratification and intraoperative stroke prevention strategies are crucial for enhancing patient safety and surgical success.
Abstract

Keywords:
in-hospital mortalitymitral valve surgerymorbidityperioperative stroke

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