Carotid artery stenosis as an independent risk factor for perioperative strokes following mitral valve surgical
Reshmi Udesh1, Pawan Solanki1, Amol Mehta1
1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Insights
Carotid stenosis (CS) is a significant risk factor for perioperative stroke after mitral valve surgery. Identifying and managing CS may help reduce stroke incidence in these high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Epidemiology
Background:
- Mitral valve surgery carries a risk of perioperative stroke.
- Independent risk factors for stroke require further investigation.
Purpose of the Study:
- To examine the role of carotid stenosis (CS) and other independent risk factors in perioperative stroke.
- To identify predictors of stroke following mitral valve repair or replacement.
Main Methods:
- Analysis of the National Inpatient Sample (NIS) database.
- Identification of patients undergoing mitral valve repair or replacement using ICD-9 codes.
- Risk stratification using Van Walraven (VWR) scoring.
Main Results:
- 3.39% of 79,583 patients experienced perioperative stroke.
- Significant stroke predictors included age, female gender, high VWR risk, symptomatic and asymptomatic CS, atrial fibrillation, smoking history, other cardiac valve procedures, and congestive heart failure (CHF).
- Increased stroke incidence observed in age groups 65-74 and 75-84.
Conclusions:
- Carotid stenosis (CS) is a significant risk factor for perioperative stroke after mitral valve surgery.
- Further prospective studies are needed for risk stratification and to evaluate carotid revascularization benefits.
- Improved patient selection and targeted interventions may reduce stroke rates.
Objective:
To examine the role of carotid stenosis (CS) and other independent risk factors of perioperative stroke following either mitral valve repair or replacement.
Methods:
Using data from the National Inpatient Sample (NIS) database for analysis, all patients who underwent either mitral valve repair or replacement were identified using ICD-9 codes.
Results:
A total of 79,583 patients who underwent either mitral valve replacement or repair were studied. 3.39% of the total cohort developed perioperative stroke. With a mean age of 62.78±0.23, there was a statistically significant amount of stroke cases in age ranges 65-74 and 75-84 (p<0.05). Risk stratification was done using Van Walraven (VWR) scoring and the cohort had a mean of 2.73±0.06. The following independent predictors were found to be significant: age, female gender, moderate and high VWR risk, both symptomatic and asymptomatic CS, atrial fibrillation, previous h/o smoking, and other cardiac valve procedures performed, and congestive heart failure (CHF).
Conclusion:
CS is a significant risk factor for perioperative strokes following mitral valve surgery. Further prospective clinical studies are needed that look into risk stratification of patients for better patient selection and the question of whether carotid revascularization procedures will be beneficial in reducing stroke rates.
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