title: In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective.
abstract: BACKGROUND
  Stroke is a widely recognized complication after aortic valve replacement (AVR), especially among elderly patients. The literature contains substantial variability in reports of the actual incidence of stroke after AVR among high-risk patients. Our objective was to define risk of stroke in patients undergoing surgical AVR, using a large national database.
  
  
  METHODS
  We used the 2002 to 2011 Nationwide Inpatient Sample database for this analysis. All patients undergoing isolated AVR, or AVR with coronary artery bypass grafting (AVR + CABG), were identified using standard International Classification of Diseases codes. In-hospital mortality and any adverse neurologic event were the primary outcomes of the study.
  
  
  RESULTS
  The incidence of in-hospital mortality was 3.0% and 5.1%, respectively, among patients undergoing isolated AVR and AVR + CABG; it was significantly lower in high-volume centers. The incidence of any adverse neurologic event was 2.0% and 2.9%, respectively, among patients undergoing isolated AVR, and AVR + CABG. We demonstrated a progressive increase in the risk of in-hospital mortality and adverse neurologic events with increasing age. Neurologic events increased with age, from 1.3% for patients aged <70 years, to 3.2% for those aged >85 years, for isolated AVR; and from 2.3% to 3.6% for AVR + CABG. The incidence of in-hospital mortality was as high as 5.7% and 7.4%, respectively, among patients aged >85 years undergoing isolated AVR, and AVR + CABG. Similarly, the incidence of any adverse neurologic event was 3.2% and 3.6%, respectively, among patients aged >85 years undergoing isolated AVR, and AVR + CABG. In addition, the risk of adverse neurologic events was significantly higher in the high-risk surgical cohort, compared with the low-risk surgical cohort (odds ratio [95% confidence interval]; isolated AVR: 2.38 [1.99-2.86]; AVR + CABG: 1.88 [1.57-2.24]).
  
  
  CONCLUSIONS
  The incidence of in-hospital mortality and adverse neurologic events was significantly higher among patients with advanced age and elevated surgical risk.
authors.affiliation: Department of Cardiovascular Medicine, Section of Interventional Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Shikhar
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Aatish
authors.initials: A
authors.lastname: Garg
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Akhil
authors.initials: A
authors.lastname: Parashar
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
authors.affiliation: Department of Cardiovascular Medicine, Section of Interventional Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Navia
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Mick
authors.affiliation: Department of Cardiovascular Medicine, Section of Interventional Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: kapadis@ccf.org.
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality*; D017052:Hospital Mortality; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: aortic valve replacement; mortality; stroke