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Stroke risk high for patients undergoing aortic valve repair

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Stroke occurrence after aortic valve surgery appears to be higher than expected, researchers reported at the International Stroke Conference 2013.

The risk for stroke complicating aortic valve repair is estimated to range from 2% to 10%; however, outcomes have not been well documented, according to Steven R. Messé, MD, assistant professor of neurology at University of Pennsylvania, and colleagues.

 

Steven R. Messé

The prospective, cohort study included 196 patients (mean age, 76 years; 36% women; 5% non-white) undergoing open aortic valve repair for calcific moderate to severe aortic stenosis. Patients underwent MRI after surgery and were evaluated by a neurologist prior to surgery and at post-operative day 1, 3 and 7.

Clinical stroke was defined as new neurological symptoms lasting more than 24 hours; transient ischemic attack with neurologic symptoms lasting less than 24 hours and without evidence of stroke; or silent stroke presenting as a lesion on MRI, without signs or symptoms of a stroke, according to a press release.

Researchers found that 60% of patients who underwent MRI after aortic valve repair had infarcts. Seventeen percent of patients experienced clinical strokes and 2% experienced TIA. Most strokes were mild (median NIH Stroke Scale, 3). In-hospital mortality occurred in 5% of patients.

The median length of stay for patients with clinical stroke was 12 days, compared with 10 days for patients without stroke.

Moderate or severe stroke (NIHSS >10) occurred in 4% of patients and was associated with a 38% in-hospital death rate as compared with a 4% death rate for all others.

Silent infarcts were identified in 55% of 112 stroke-free patients who had postoperative imaging; however, this finding was not associated with in-hospital death or increased length of stay.

For more information:

Messé SR. Abstract #199. Presented at: International Stroke Conference 2013; Feb. 5-8, 2013; Honolulu.

Disclosure: Messe reports receiving funding from the NIH.