Abstract 13322: In-hospital Death and Stroke Following Surgical Aortic Valve Replacement: a Nationwide Perspective

Abstract

Significant heterogeneity exists in the current literature around the actual incidence of stroke following aortic valve replacement (AVR) among high-risk patients. We aimed to evaluate the risk of stroke in patients undergoing surgical AVR from a large national database. Methods: We used the 2002-2011 Nationwide Inpatient Sample for this analysis. All patients undergoing isolated AVR or AVR with coronary artery bypass grafting (AVR+CABG) were identified using ICD codes. In-hospital death and any adverse neurological event were co-primary outcomes. Based on predicted death estimates, the study population was classified into low (<8%) and high (≤8%) surgical risk Results: Incidence of in-hospital death was 3.0% and 5.1% among patients undergoing isolated AVR and AVR+CABG respectively. The incidence of adverse neurological event was 2.0% and 2.9% among patients undergoing AVR and AVR+CABG respectively. We demonstrated a progressive increase in the risk of in-hospital death and adverse neurological events with increasing age (Fig 1). The incidence of in-hospital death was as high as 5.7% and 7.4% among patients aged ≤ 85 years undergoing isolated AVR and AVR+CABG respectively. Similarly, the incidence of any adverse neurologic event was 3.2% and 3.6% among patients aged ≤ 85 years undergoing isolated AVR and AVR+CABG respectively. We demonstrated a significantly higher risk of adverse neurological events among the high-risk cohort as compared to the low-risk cohort. Among patients undergoing isolated AVR, the incidence of any adverse neurological event was 1.8% and 4.8% in the low-risk and the high-risk cohorts respectively. Similarly, among patients undergoing AVR+CABG, the incidence of any adverse neurological event was 2.7% and 5.4% in the low-risk and the high-risk cohorts respectively. Conclusions: The incidence of in-hospital death and adverse neurological events was significantly higher among patients with advanced age and elevated surgical risk.