Evaluation of neurological events following minimally invasive mitral valve surgery

Abstract

Objective: To determine the rate of neurological events in patients undergoing minimally invasive mitral valve surgery and evaluate factors associated with the groups with and without postoperative neurological events. Subjects and Methods: Inclusion Criteria: Patients undergoing minimally invasive mitral valve surgery at the Cardiac Surgery Department, University Medical Center. Exclusion Criteria: Patients with infective endocarditis, patients requiring ECMO support. Study Design: Retrospective case series study. Results: A total of 358 patients underwent minimally invasive mitral valve surgery between 2017 and 2022, with an average age of 50.7 years. Male patients accounted for 53.2%, and the surgical risk according to EuroScore II was 1.6%. Neurological complications occurred in 46 patients, representing 12.8%. Among these, delirium was the most common complication, occurring in 42 patients (91.3%), while stroke with sequelae occurred at a lower rate of 2.2%. The average age of the group with neurological complications was higher than that of the group without complications (53.9 ± 10.8 years vs. 50.2 ± 12.6 years). Additionally, the male proportion in the complication group (63.0%) was higher than in the group without complications (50.6%). The history of stroke in the complication group was 4.3%. The duration of mechanical ventilation and ICU stay was longer in the group with neurological complications, with an average mechanical ventilation time of 36.1 ± 71.3 hours compared to 18.4 ± 24.5 hours in the group without complications. The rate of new-onset atrial fibrillation after surgery was also higher in the complication group (19.6% vs. 10.6%). Conclusion: Neurological complications after surgery are a significant issue, occurring in 12.8% of patients undergoing minimally invasive mitral valve surgery, with delirium and stroke being the most common. Key risk factors include age, hypertension, and atrial fibrillation.