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Prior stroke may confer poor outcomes in surgical AVR
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Previous stroke was associated with recurrent stroke and major adverse CV events in patients undergoing surgical aortic valve replacement, according to a study.
The researchers analyzed 14,030 patients from Danish administrative registries who underwent surgical AVR between 1996 and 2014. Of the cohort, 616 patients had prior stroke (mean age, 72 years; 31% women) and 13,414 did not (mean age, 70 years; 36% women).
Patients were further stratified by elapsed time from stroke: less than 3 months; 3 to 12 months; 12 months or more; or no prior stroke.
The outcomes of interest were major adverse CV events, stroke and all-cause mortality at 30 days.
Compared with those who had no prior stroke, absolute risk for ischemic stroke was elevated in patients with stroke less than 3 months before surgery (18.4% vs. 1.2%; OR = 14.69; 95% CI, 9.69-22.27), Charlotte Andreasen, MD, from the department of cardiology at Copenhagen University Hospital Herlev and Gentofte in Denmark, and colleagues wrote.
Patients with stroke less than 3 months before surgery also had increased risk for major adverse CV events compared with patients with no prior stroke (23.3% vs. 5.7%; OR = 4.57; 95% CI, 3.24-6.44), but the same was not true for all-cause mortality (6.8% vs. 3.6%; OR = 1.45; 95% CI, 0.83-2.54).
ORs declined over time for all outcomes and stabilized between 2 and 4 months, according to the researchers.
“Data suggest that postponement of [surgical] AVR for at least 3 to 4 months after a stroke, if possible, may reduce the risk of recurrent stroke during surgery,” Andreasen and colleagues wrote. “However, because of the observational nature of this study, the results are only hypothesis-generating, and more studies are encouraged before drawing such a conclusion.”
During the same period, 1,508 patients, 132 of whom had a prior stroke, underwent transcatheter AVR, and the results were similar to the surgical AVR cohort, according to the researchers.
In a related editorial, Michael T. Mullen, MD, and Steven R. Messé, MD, both from the department of neurology at the University of Pennsylvania, wrote: “Because of changes in clinical practice over time, the results may not be generalizable to the present day. This is particularly true for transcatheter aortic valve implantation, which was initially reserved for high-risk patients but is now performed more broadly.
“Although this is an area that requires additional study, for now, it seems reasonable to avoid aortic valve surgery or any surgery within the first 3 months after a stroke unless the procedure is urgent or emergent and waiting would be harmful,” they wrote. “The old saw that patience is a virtue certainly seems to hold for cardiac surgery after a stroke.” – by Erik Swain
Disclosures: Andreasen and Mullen report no relevant financial disclosures. Messé reports he received consultant fees and personal fees from Claret Medical. Please see the study for all other authors’ relevant financial disclosures.
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