Abstract 199: Stroke After Aortic Valve Surgery: Results From A Prospective Cohort

Abstract

Introduction: Aortic valve disease is increasing in prevalence as the population ages. The reported risk of stroke complicating surgical aortic valve repair has ranged widely from 2-10% and its impact on outcome is not well characterized as prior data have come from single centers without systematic evaluation by neurologists. We hypothesized that stroke complications of aortic valve repair have been underestimated in prior cohorts. Methods: We performed a prospective cohort study of patients ≥ 65 years old undergoing open surgical aortic valve repair for calcific moderate to severe aortic stenosis. Patients underwent pre- and post-operative MRI, and were evaluated by neurologists at post-operative day 1, 3, and 7. Cerebrovascular endpoints were independently adjudicated by two vascular neurologists. Clinical stroke was defined as new focal neurologic symptoms lasting > 24 hours determined to be of vascular origin, TIA as neurologic symptoms lasting < 24 hours and without evidence of infarction, and silent infarct as imaging evidence of acute infarct without clinical symptoms. Results: Over a 4 year period, 184 subjects were enrolled, age 75.7 ± 6.3 years, 36% female, and 5% non-white. Clinical strokes were identified in 30 (16%) patients, TIA in 4 (2%), and in-hospital mortality occurred in 9 (5%) of patients. Most strokes were mild; the median NIHSS was 3 (IQR 1 - 9). Clinical stroke was associated with increased length of stay, median 12.5 vs 10 days, p=0.006. Moderate or severe stroke (NIHSS≥10) which occurred in 7 (4%) was strongly associated with in-hospital mortality 43% vs 3%, p =0.003. Post-op MRI was not obtained in 55 subjects, often due to concomitant illness; of those, 15 (27%) had clinical strokes and 8 (15%) died. Of the 114 stroke-free subjects with post-op imaging, silent infarct was identified in an additional 49 (43%). Silent infarct was not associated with in-house mortality or length of stay. Conclusions: Cerebral infarction was detected in over 40% of patients undergoing aortic valve repair. Clinical stroke complicating valve surgery is associated with increased length of stay and mortality.