title: Frequency of and determinants of stroke after surgical aortic valve replacement in patients with previous cardiac surgery (from the Multicenter RECORD Initiative).
abstract: Surgical aortic valve replacement (S-AVR) after previous cardiac surgery is expected to be associated with a high rate of adverse events. The aim of this study was to estimate the rate and identify the determinants of postoperative stroke in these patients. This is a multicenter study including 741 patients who underwent S-AVR after previous cardiac surgery. Forty-eight patients (6.5%; after isolated AVR, 6.0%) suffered stroke and 10 of them died during the in-hospital stay (20.8%). At multivariate analysis, women (10.2% vs 4.4%, odds ratio [OR] 2.57, 95% confidence interval [CI] 1.36 to 4.86), emergency procedure (15.1% vs 4.8%, OR 2.63, 95% CI 1.12 to 5.78), perioperative use of intra-aortic balloon pump (22.9% vs 5.3%, OR 2.67, 95% CI 1.15 to 6.19), cardiopulmonary bypass time of >210 minutes (15.7% vs 5.0%, OR 2.31, 95% CI 1.13 to 4.71), blood products transfusion (9.3% vs 0.8%, OR 7.75, 95% CI 1.83 to 32.93), and reexploration for bleeding (24.0% vs 5.2%, OR 4.84, 95% CI 2.18 to 10.77) were independent predictors of postoperative stroke. These findings were confirmed by a regression model including CHA2DS2-VASc score of ≥2, which itself was predictive of stroke (8.2% vs 1.6%, OR 4.52, 95% CI 1.34 to 15.28). Survival at 3 years in patients with postoperative stroke was 51.9%, whereas it was 85.0% in control patients (adjusted analysis: relative risk 2.97 and 1.86 to 4.72, respectively). In conclusion, the risk of postoperative stroke after S-AVR in patients with previous cardiac surgery is high and has an impact on the immediate and late mortality. Excessive bleeding requiring blood transfusion and/or reexploration, prolonged cardiopulmonary bypass time, and use of intra-aortic balloon pump were associated with an extremely high rate of stroke.
authors.affiliation: Division of Cardiac Surgery, University of Oulu, Oulu, Finland.
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mariscalco
authors.forename: Marisa
authors.initials: M
authors.lastname: De Feo
authors.forename: Antonio
authors.initials: A
authors.lastname: Messina
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santarpino
authors.forename: Francesco
authors.initials: F
authors.lastname: Santini
authors.forename: Cesare
authors.initials: C
authors.lastname: Beghi
authors.forename: Gianantonio
authors.initials: G
authors.lastname: Nappi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Troise
authors.forename: Theodor
authors.initials: T
authors.lastname: Fischlein
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Passerone
authors.forename: Jouni
authors.initials: J
authors.lastname: Heikkinen
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Faggian
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006331:Heart Diseases / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications; D011379:Prognosis; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D015996:Survival Rate / Q000639:trends