PMID- 18355659
OWN - NLM
STAT- MEDLINE
DCOM- 20080417
LR  - 20220311
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 51
IP  - 12
DP  - 2008 Mar 25
TI  - Thromboembolic complications after surgical correction of mitral regurgitation 
      incidence, predictors, and clinical implications.
PG  - 1203-11
LID - 10.1016/j.jacc.2007.10.058 [doi]
AB  - OBJECTIVES: We sought to define thromboembolic risk after surgery for mitral 
      regurgitation (MR), particularly ischemic stroke (IS) compared with the general 
      population. BACKGROUND: Guidelines recommend surgery in asymptomatic patients 
      with MR, but IS risks are unknown. METHODS: In 1,344 patients (age 65 +/- 12 
      years) consecutively operated for MR (procedures: 897 mitral valve repair [MRep] 
      and 447 valve replacement: 231 mechanical mitral valve replacement [MVRm], 216 
      biological mitral valve replacement [MVRb]), thromboembolic complications, 
      particularly IS (diagnosed by neurologists), during follow-up were assessed early 
      (<30 days), midterm (30 to 180 days), and long-term (>or=180 days). RESULTS: 
      Ischemic stroke occurred in 130 patients: 1.9 +/- 0.4% and 2.7 +/- 0.5% at 30 
      days and 180 days, respectively, and 8.1 +/- 0.8% at 5 years. We found that IS 
      rates were lowest after MRep versus MVRb and MVRm (6.1 +/- 0.9% vs. 8 +/- 2.1%, 
      and 16.1 +/- 2.7% at 5 years, respectively, p < 0.001). Comparison with 
      population-expected IS showed high risk at <30 days (risk ratio 41, 95% 
      confidence interval 26 to 60, p < 0.001 but p > 0.10 between procedures) and 
      moderate risk at >30 days (risk ratio 1.7 overall; 1.3 for MRep; 0.98 for MVRb; 
      4.8 for MVRm). Beyond 180 days, IS risk declined further and was similar to the 
      population for MRep (relative risk 1.2) and for MVRb (relative risk 0.9). 
      Bleeding risk >30 days was lowest in MRep versus MVRb and MVRm (10-year risk 7 
      +/- 1%, 14 +/- 4%, and 16 +/- 3%, respectively). CONCLUSIONS: Thromboembolic 
      complications after MR surgery are a reason for both concern and encouragement. 
      The risk of IS is notable early, irrespective of procedure, but in the long term 
      it is not greater than in the population after MRep and MVRb. Preference for MRep 
      should be emphasized, and trials aiming at preventing IS should be conducted to 
      reduce thromboembolic and hemorrhagic risk after surgery for MR.
FAU - Russo, Antonio
AU  - Russo A
AD  - Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of 
      Medicine, Rochester, Minnesota 55905, USA.
FAU - Grigioni, Francesco
AU  - Grigioni F
FAU - Avierinos, Jean-Francois
AU  - Avierinos JF
FAU - Freeman, William K
AU  - Freeman WK
FAU - Suri, Rakesh
AU  - Suri R
FAU - Michelena, Hector
AU  - Michelena H
FAU - Brown, Robert
AU  - Brown R
FAU - Sundt, Thoralf M
AU  - Sundt TM
FAU - Enriquez-Sarano, Maurice
AU  - Enriquez-Sarano M
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
CIN - J Am Coll Cardiol. 2008 Mar 25;51(12):1212-3. PMID: 18355660
MH  - Aged
MH  - Female
MH  - Forecasting
MH  - Heart Valve Prosthesis Implantation/*adverse effects
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/surgery
MH  - Mitral Valve Insufficiency/*surgery
MH  - Postoperative Hemorrhage/*etiology
MH  - Risk Assessment
MH  - Stroke/*etiology
MH  - Thromboembolism/*epidemiology/etiology
MH  - Treatment Outcome
EDAT- 2008/03/22 09:00
MHDA- 2008/04/18 09:00
CRDT- 2008/03/22 09:00
PHST- 2007/05/01 00:00 [received]
PHST- 2007/09/24 00:00 [revised]
PHST- 2007/10/01 00:00 [accepted]
PHST- 2008/03/22 09:00 [pubmed]
PHST- 2008/04/18 09:00 [medline]
PHST- 2008/03/22 09:00 [entrez]
AID - S0735-1097(08)00060-0 [pii]
AID - 10.1016/j.jacc.2007.10.058 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2008 Mar 25;51(12):1203-11. doi: 10.1016/j.jacc.2007.10.058.