title: Perioperative Strokes and Early Outcomes in Mitral Valve Surgery: A Nationwide Analysis.
abstract: OBJECTIVE
  To demonstrate the role of perioperative stroke as an independent risk factor for in-hospital morbidity and mortality after mitral valve surgery and review the trends in the early outcomes of mitral valve surgery over the past decade.
  
  
  METHODS
  Using data from the National Inpatient Sample database for analysis, all patients who underwent isolated mitral valve procedures were identified using International Classification of Diseases-Ninth Revision codes. Univariate and multivariate analyses of risk factors of in-hospital mortality and morbidity were performed.
  
  
  METHODS
  Multi-institutional.
  
  
  METHODS
  The study comprised patients who underwent mitral valve procedures from 1999 to 2011.
  
  
  METHODS
  Mitral valve repair or replacement.
  
  
  RESULTS
  Data on 21,821 patients showed an in-hospital mortality of 5.5% and morbidity of 63.30% (p<0.05). Perioperative strokes were experienced by 3.89% of the cohort after isolated mitral valve surgery (p<0.05). Independent predictors of adverse outcomes were age, female sex, emergency surgery, arrhythmias, hypertension, renal failure, coagulopathy, neurologic disorders, weight loss, anemia, postoperative cardiac arrest, and myocardial infarction. Perioperative strokes were found to be the strongest risk factor for postoperative mortality (odds ratio 2.34, 95% confidence interval 1.83-2.98) and morbidity (odds ratio 4.53, 95% confidence interval 3.34-6.15).
  
  
  CONCLUSIONS
  Age, female sex, emergency surgery, arrhythmias, hypertension, renal failure, coagulopathy, neurologic disorders, weight loss, fluid and electrolyte imbalance, anemia, postoperative cardiac arrest, and myocardial infarction were found to be significant predictors of morbidity and mortality after mitral valve surgery, with perioperative strokes posing the strongest risk. The trends in the last 10 years indicated a decrease in mortality and an increase in morbidity. Preoperative risk stratification and intraoperative identification for impending strokes appear warranted.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Reshmi
authors.initials: R
authors.lastname: Udesh
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Amol
authors.initials: A
authors.lastname: Mehta
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Gleason
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Wechsler
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: thirumalapd@upmc.edu.
authors.forename: Parthasarathy D
authors.initials: PD
authors.lastname: Thirumala
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000639:trends; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality*; D020521:Stroke / Q000175:diagnosis / Q000401:mortality*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: in-hospital mortality; mitral valve surgery; morbidity; perioperative stroke