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DOI: 10.1055/s-0034-1367192
Incidence and determinants of stroke after surgical aortic valve replacement in patients with prior cardiac surgery: Results from the multicenter RECORD initiative
Objectives: Surgical aortic valve replacement (S-AVR) after prior 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.
Methods: This is a multicenter study including 741 patients who underwent S-AVR after prior cardiac surgery during the last 10 years at 7 institutions. The determinants of stroke were analyzed. Outcome was further investigated.
Results: Forty-eight patients (6.5%) suffered stroke and ten of them died during the in-hospital stay (20.8%). At multivariate analysis, females (10.2% vs. 4.4%, OR 2.53, 95%CI 1.33-4.78), emergency procedure (15.1% vs. 4.8%, OR 2.43, 95%CI 1.23-4.82), perioperative use of intraaortic balloon pump (22.9% vs. 5.3%, OR 2.73, 95%CI 1.18-6.33), cardiopulmonary bypass time > 210 min (15.7% vs. 5.0%, OR 2.36, 95%CI 1.16-4.82), blood products transfusion (9.3% vs. 0.8%, OR 7.30, 95%CI 1.71-31.12) and re-exploration for bleeding (24.0% vs. 5.2%, OR 4.86, 95%CI 2.17-10.88) were independent predictors of postoperative stroke. These findings were confirmed by a regression model including CHA2DS2-VASc score ≥ 2, which itself was predictive of stroke (8.2% vs. 1.6%, OR 4.82, 95%CI 1.42-16.34). Survival at 3 years in patients with postoperative stroke was 51.9%, whereas it was 85.0% in control patients (adjusted analysis: RR 2.97, RR 1.86-4.72).
Conclusion: The risk of postoperative stroke after S-AVR in patients with previous cardiac surgery is extremely high and has an impact on the immediate and late mortality. Excessive bleeding requiring blood transfusion and/or re-exploration, prolonged CPB, and use of intraaortic balloon pump were associated with an extremely high rate of stroke.