Arterial risk factors and ischemic cerebrovascular events after aortic valve replacement.
To assess the association of possible risk factors with ischemic cerebrovascular events after aortic valve replacement (AVR), 619 consecutive patients undergoing AVR with a Medtronic Hall valve between the beginning of December 1979 and the end of December 1992 and surviving the immediate postoperative period were analyzed. Possible risk factors examined were valve lesion, prosthesis size, postoperative functional status, systemic hypertension, cigarette smoking, diabetes, coronary artery disease and atrial fibrillation. There were 53 ischemic cerebrovascular events in 38 patients during 3,174 follow up years, yielding a linearized event rate of 1.7%/patient-year. Significant risk factors in terms of odds ratios (OR) were postoperative hypertension (OR 8.0), postoperative NYHA class III or IV (OR 5.5), postoperative smoking (OR 4.0), diabetes (OR 3.5), preoperative hypertension (OR 2.7) and preoperative smoking (OR 1.8). There was highly significant interaction between postoperative hypertension and postoperative smoking (OR 54.0). Eighty-one percent of patients who suffered events were hypertensive or smoking postoperatively or both. These findings have important implications for postoperative management and for the reporting of ischemic cerebrovascular events after valve replacement.
Butchart
E G
EG
Department of Cardiac Surgery, University Hospital, University of Wales College of Medicine, Cardiff, United Kingdom.
Moreno de la Santa
P
P
Rooney
S J
SJ
Lewis
P A
PA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D002545:Brain Ischemia / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery; D006350:Heart Valve Prosthesis; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects