Thorac Cardiovasc Surg 2014; 62 - OP118
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

G. Santarpino 1, F. Biancari 2, F. Onorati 3, G. Mariscalco 4, M. De Feo 5, A. Messina 6, F. Santini 7, C. Beghi 4, G. Nappi 5, G. Troise 6, G. Passerone 7, J. Heikkinen 2, G. Faggian 3, T. Fischlein 1
  • 1Klinikum Nürnberg, Cardiac Surgery, Nürnberg, Germany
  • 2University of Oulu, Cardiac Surgery, Oulu, Finland
  • 3University of Verona Medical School, Cardiac Surgery, Verona, Italy
  • 4Varese University Hospital, Varese, Italy
  • 5Second University of Naples, Department of Cardiothoracic and Respiratory Sciences, Napoli, Italy
  • 6Poliambulanza Foundation Hospital, Brescia, Cardiac Surgery, Brescia, Italy
  • 7San Martino University Hospital Genoa, Cardiac Surgery, Genoa, Italy

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.