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Perioperative Stroke and Mortality After Surgical Aortic Valve Replacement: A Meta-Analysis
Karthy Thiagarajan1, Vinodh Jeevanantham, Raymond Van Ham
1Departments of *Neurological Surgery §Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh Medical Center ‡University of Pittsburgh School of Medicine, Pittsburgh, PA †Saint Anthony Hospital, Oklahoma City, OK ∥Division of Cardiothoracic Surgery, West Virginia University, Morgantown, WV.
Insights
Perioperative stroke significantly increases operative mortality risk after surgical aortic valve replacement (SAVR). Patients experiencing stroke have nearly five times greater odds of death, highlighting the need for improved stroke prevention strategies.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Critical Care Medicine
Background:
- Surgical aortic valve replacement (SAVR) carries variable perioperative stroke rates (1.3%-6.2%) and operative mortality (1%-16.4%).
- Understanding the relationship between perioperative stroke and mortality is crucial for risk stratification and patient management.
Purpose of the Study:
- To determine if perioperative stroke is an independent risk factor for operative mortality following SAVR.
- To quantify the increased odds of mortality associated with perioperative stroke in SAVR patients.
Main Methods:
- A meta-analysis of studies retrieved from PubMed, EMBASE, and Web of Science was conducted.
- A random effects model was employed to calculate the odds of mortality in patients with perioperative strokes.
- Subgroup analyses and metaregression explored associations with patient demographics and clinical factors.
Main Results:
- Patients experiencing perioperative strokes had 4.74 times greater odds of operative mortality after SAVR.
- This association remained significant and independent of covariates including sex, valve type, NYHA class, ejection fraction, and atrial fibrillation.
Conclusions:
- Perioperative stroke is a significant independent risk factor for operative mortality after SAVR.
- Patients with perioperative strokes face a nearly fivefold increase in early mortality risk.
- Enhanced preventive strategies for perioperative stroke in SAVR are warranted.
Objective:
Perioperative stroke rate after surgical aortic valve replacement (SAVR) varies between 1.3% and 6.2%, whereas the operative mortality ranges between 1% and 16.4%. The aim of this study was to determine whether perioperative stroke is a risk factor for operative mortality after SAVR by performing a meta-analysis of relevant studies.
Materials And Methods:
PubMed, EMBASE, and Web of Science databases were searched to retrieve relevant literature. Screening of the articles was done independently on the basis of predetermined criteria. Data from the relevant studies were extracted and a random effects model was used to calculate the odds of mortality among patients with perioperative strokes after aortic valve replacement compared with those without such strokes. Subgroup analyses of patients (1) aged above and below 70 years and (2) undergoing isolated valve replacement procedure were performed. Metaregression to check for association of effect estimate and (1) sex, (2) mechanical valve replacement, (3) New York Heart Association class III/IV, (4) left ventricle ejection fraction <30%, and (5) preoperative atrial fibrillation was performed.
Results:
Statistical analyses using a random effects model showed that patients with perioperative strokes had 4.74 times greater odds for operative mortality after SAVR, independent of the following covariates: (1) sex, (2) mechanical valve replacement, (3) New York Heart Association class III/IV, (4) left ventricle ejection fraction <30%, and (5) preoperative atrial fibrillation.
Conclusions:
Patients with perioperative strokes after SAVR have nearly 5 times greater odds of experiencing operative mortality compared with those without. Thus, perioperative strokes are associated with increased risk of early mortality and require further examination of preventive strategies.
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