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Related Experiment Videos

Decreasing incidence of stroke during valvular surgery

M A Borger1, J Ivanov, R D Weisel

  • 1Division of Cardiovascular Surgery, Toronto Hospital, Ontario, Canada.

Circulation
|December 16, 1998
PubMed
Summary

Stroke incidence during valvular surgery decreased over 15 years, despite rising risk factors. Key predictors include endocarditis, advanced age, and urgent procedures, suggesting causes like emboli and shock.

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Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Public Health

Background:

  • Stroke following valvular surgery remains incompletely understood.
  • Identifying stroke predictors and mechanisms is crucial for patient outcomes.

Purpose of the Study:

  • To examine the incidence, predictors, and mechanisms of stroke during valvular procedures.
  • To analyze stroke trends over a 15-year period.

Main Methods:

  • Retrospective review of prospectively gathered data from 5954 patients (1982-1996).
  • Stroke defined by persistent neurological deficit, often confirmed by CT imaging.
  • Multivariable logistic regression used to identify independent predictors.

Main Results:

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  • Stroke incidence decreased from 3.8% (1982-1986) to 2.6% (1992-1996).
  • Independent predictors: endocarditis, age >74, earlier operation period, urgent timing, concomitant coronary bypass, and reoperation.
  • Increasing prevalence of older patients, urgent procedures, and bypass surgery noted in later years.

    • Conclusions:

    • Stroke incidence during valvular surgery has declined over time.
    • Despite increased risk factors, improved management or surgical techniques may explain the decrease.
    • Major stroke causes identified: atherosclerotic emboli, shock, and septic emboli.