Abstract Background Single coronary artery (SCA) is a rare congenital anomaly that may have serious clinical consequences in different clinical settings despite often being asymptomatic. Case Summary We report a case of a 75-year-old patient with a SCA originating from the right sinus of Valsalva presenting for pre-operative assessment for mitral valve (MV) stenosis. The patient developed cardiogenic shock post MV replacement surgery on grounds of iatrogenic occlusion of the ectopic left main coronary artery which was treated with a percutaneous revascularization procedure. Discussion SCA represents a major anatomical variant that can significantly impact clinical outcomes, particularly during cardiac surgery. An abnormal coronary anatomy poses technical challenges, due to potential inadvertent injury or compression of the anomalous artery relative to the extent of the myocardium at risk.

Rationale:Endogenous fungal endophthalmitis (EFE) is a rare but sight- and life-threatening condition that often arises in immunocompromised patients. While Aspergillus fumigatus is the predominant pathogen, Aspergillus niger-associated endocarditis leading to bilateral EFE has not been previously reported.Patient concerns:A 51-year-old woman with a history of two renal transplants over the past 30 years, along with diabetes mellitus, hypertension, and ongoing immunosuppressive therapy, presented with rapidly progressive bilateral visual impairment, beginning with acute vision loss and ocular pain in the right eye, followed by involvement of the left eye within two days. She had no systemic symptoms such as fever, chest pain, or dyspnea.Diagnosis:Initial aqueous humor analysis, including Gram staining, fungal culture, and viral PCR, yielded negative results. As the disease progressed to bilateral involvement within 2 days, a diagnostic vitrectomy was performed. Vitreous sampling demonstrated fungal hyphae, and culture confirmed Aspergillus niger. Transesophageal echocardiography further revealed mitral valve vegetation, establishing the diagnosis of fungal infective endocarditis with bilateral endogenous endophthalmitis.Interventions:The patient received empiric intravitreal antibiotics and antivirals initially, followed by diagnostic pars plana vitrectomy and systemic antifungal therapy after identification of Aspergillus. Mitral valve replacement surgery was subsequently performed.Outcomes:Despite surgical intervention and systemic antifungal treatment, the patient developed disseminated fungal sepsis and died 2 weeks after valve replacement.Lessons:This case highlights the diagnostic challenges of EFE and emphasizes the importance of considering fungal endocarditis as a source of infection in immunosuppressed patients presenting with severe vitritis, even in the absence of systemic symptoms. Early recognition, prompt vitrectomy with intravitreal antifungal therapy, and thorough systemic evaluation are essential to improve visual and systemic outcomes.

BackgroundMitral annular calcification (MAC) is a chronic and degenerative process, affecting the mitral valve annulus. MAC complicates the decision over the appropriate surgical approach to mitral valve disease. Distorted valvular anatomy increases surgical risk and therefore requires careful patient selection. Here, we report our single-center experience performing mitral valve surgery in the setting of MAC over a 10-year period.MethodsThis is a 10-year retrospective analysis of 172 patients with MAC. Sixty-seven patients underwent MAC severity scoring using a 10-point system based on computed tomography (CT). The primary outcome was 30-day mortality, readmission, reoperation, stroke, prolonged ventilation, renal failure and deep sternal infection. Secondary analyses stratified MAC by underlying mitral disease type as well as evaluated outcomes by CT severity score. Patients without MAC undergoing mitral valve replacement surgery during the same time period served as controls.ResultsThe 30-day mortality was significantly higher in MAC patients compared with non-MAC (9.9% vs. 4.2%, P<0.001), as were rates of stroke (4.7% vs. 1.6%, P=0.036), prolonged ventilation (33.1% vs. 21.1%, P<0.001), and renal failure (8.7% vs. 4.3%, P=0.008). Resource utilization was also greater, with longer intensive care unit (ICU) hours {118 [interquartile range (IQR), 58.2–254] vs. 72.3 (IQR, 41.0–141.5) hours, P<0.001}, postoperative length of stay [10 (IQR, 7–22) vs. 8 (IQR, 6–13) days, P<0.001], and total hospitalization [12 (IQR, 8–28) vs. 10 (IQR, 6–17) days, P=0.001].ConclusionsMAC complicates mitral valve surgery, with significant differences seen in survival stroke, renal failure, prolonged ventilatory support, and ICU and hospital length of stay. Careful evaluation of surgical risk and patient selection is warranted in patients with MAC.

To report a rare case of catastrophic antiphospholipid syndrome (CAPS) following surgery for Libman-Sacks endocarditis (LSE), and to clarify the clinical relationship between antiphospholipid syndrome (APS), LSE and CAPS. We analysed the clinical course of a patient who developed CAPS after mitral valve replacement surgery for LSE. A literature review was conducted to explore the systemic nature of APS and its cardiac and thrombotic manifestations. A 53-year-old woman initially presented with cerebral infarction and was found to have mitral valve vegetations. Although APS-associated features were present before surgery, a diagnosis was not established at that time. Postoperatively, the patient developed multiple thrombotic events affecting the brain, spleen, kidneys and extremities. Serological testing and clinical deterioration led to the diagnosis of CAPS. Despite supportive therapy, the patient died of multi-organ failure. This case highlights the importance of recognising APS as the systemic autoimmune basis of LSE and the need for early immunologic and thrombotic evaluation in patients with unexplained valve lesions. Failure to identify underlying APS before surgery may increase the risk of CAPS and poor outcomes.

Valvular heart disease (VHD) is a growing global health concern with increasing prevalence, particularly in aging populations. While surgical valve replacement (VRS) remains a definitive treatment, limited data exists from developing countries regarding postoperative outcomes. This study aimed to evaluate mid-term clinical outcomes, specifically survival and major adverse cardiovascular events (MACE), in patients undergoing isolated mitral and aortic valve replacement surgery, and to identify factors associated with mortality. In this retrospective cohort study, 1044 patients who underwent isolated mitral or aortic VRS at Tehran Heart Center between 2003 and 2023 were analyzed. Demographic, clinical, and echocardiographic data were collected. The primary outcome was all-cause mortality; the secondary outcome was MACE. Statistical analyses included univariate and multivariate Cox regression, ROC curve analysis, and log-rank tests. The mean age of patients was 55 years, and 52% were male. Over a mean follow-up of 23.9 months, the overall mortality rate was 4.3%, and 8.4% experienced MACE. Multivariate analysis identified older age (p = 0.002) and female gender (p = 0.006) as independent predictors of mortality. Age > 50 years had a sensitivity of 85.5% and specificity of 34% for predicting mortality (AUC = 0.639, p = 0.001). No significant predictors of MACE were identified. Advanced age and female gender were associated with increased mortality following isolated VRS. These findings underscore the importance of tailored preoperative risk assessment to optimize surgical outcomes, particularly in developing healthcare settings.

Introduction: To verify the long-term durability, freedom from reoperation and mortality of Biocor and Epic bioprosthesis in mitral position. Methods: The use of biological prostheses in mitral valve replacement surgery is widespread. Advances in transcatheter techniques have increased the utilisation of these biological substitutes, rendering the study of their durability once again pertinent. Biocor and Epic are two stented tissue valves with porcine leaflets indicated for patients requiring replacement of a diseased mitral or aortic heart valve. Long-term follow-up data were collected and analysed by age group and by type of surgery. Between 2000 and 2010, 244 patients underwent mitral or double valve replacement with a Biocor or Epic bioprosthesis at our institution. The median follow-up was 9 years (IQR: 0.01- 17.9). Complete follow-up was achieved in 98.4%. Results: The survival rates at 1, 5 and 10-years were 90, 73.7 and 43 %, respectively. Freedom from prothesis reintervention from any cause at 1, 5 and 10 years was 98.5, 92.8 and 90%. Freedom from structural valve deterioration by age group at 1, 5 and 10 years was as follows: age<60: 100, 84.6 and 47.6; age 60-69: 100, 94.1 and 94.1; and age≥70: 99.4, 98.7 and 96.5% respectively.Conclusion: Our 10-year freedom from structural valve deterioration of 93.1% matches, and may even surpass those previously reported. The Epic porcine xenograft in mitral position has demonstrated to have excellent durability and long-term outcomes; representing an excellent option for patients in need for mitral valve replacement.

Rationale:Acute mitral regurgitation (MR) secondary to papillary muscle rupture is a rare but often life-threatening mechanical complication post-acute myocardial infarction (MI). The use of peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to mitral valve replacement surgery may improve outcome of such patients.Patient concerns:We reported the case of a 70-year old woman with past history who presented to the emergency department at People’s Hospital of Rizhao with “a 5-day history of chest distress.” She developed refractory cardiogenic shock, severe pulmonary edema and severe acidosis.Diagnoses:Restoration of spontaneous circulation following PCI, VA-ECMO, IABP, and early mitral valve replacement.Interventions:After performing percutaneous coronary intervention (PCI) supported by VA-ECMO and intra-aortic balloon pump (IABP), our group performed a early mitral valve replacement for this patient.Outcomes:This patient preliminarily made a good recovery after VA-ECMO and IABP discontinued.Lessons:This case demonstrated that VA ECMO combined with PCI, VA-ECMO, IABP and early mitral valve replacement can result in favorable outcomes, and might be viable emergency therapeutic options.

ObjectivesPapillary muscle rupture (PMR) is a rare but potentially fatal mechanical complication after acute myocardial infarction (AMI). Although surgery is considered the gold-standard treatment for post-AMI PMR, the optimal surgical strategy remains unclear.MethodsData from post-AMI PMR patients submitted to mitral valve replacement (MVR) or mitral valve repair (MVr) surgery in the period between 2001 and 2019, from 20 international centres, were collected in the CAUTION study database. In-hospital and long-term post-discharge mortality were the endpoints. A multivariable logistic regression model was used to determine mortality independent factors.ResultsThe patient cohort available included 218 patients. MVR was the most frequent type of surgery (81.6%). Complete PMR was more common in the MVR group (71.9%, P = .008), while partial PMR was more frequent in MVr patients (75%, P = .008). In-hospital mortality rate was 25.8% in the MVR subgroup and 20% in MVr subjects (P = .440). In MVR subgroup, concomitant coronary artery bypass grafting (CABG) was associated with lower in-hospital mortality (n = 20/96, 21%) than no concomitant CABG (31.7%, P = .035). Survival at 1, 3, 5, and 10 years was 59.3%, 55.9%, 53.1%, 46.9% in the MVR group and 59.9%, 56.8%, 54.1%, and 43.2% in MVr patients, respectively, with no statistical differences (P = .474). Patients underwent MVr surgery, and 1-, 3-, 5-, and 10-year survival was 79.8%, 75.4%, 68.5%, and 37.5%, respectively, when CABG revascularization was performed, while no CABG survival was 16.7%, 16.7%, 8.3%, and 8.3% (P < .001).ConclusionsMVR is the most commonly performed in complete post-AMI PMR and MVr in partial PMR. No differences were observed regarding in-hospital and long-term mortality in the 2 surgical groups, and no independent factors were associated with overall mortality. Concomitant CABG was associated with higher in-hospital survival.Clinical Registration NumberClinicaltrials.gov, NCT03848429.

80 Years After the First Blalock-Thomas-Taussig Shunt: Cardiac Research in Canines That Saved Lives.

ObjectivesThe study analyses perioperative outcomes in patients who underwent transcatheter electrosurgical laceration and stabilization of the clip (ELASTA-clip), followed by transapical mitral valve replacement or conventional mitral valve surgery (MVS) after failed transcatheter edge-to-edge mitral valve repair.MethodsConsecutive patients who experienced failure of a transcatheter edge-to-edge mitral valve repair and subsequently underwent either the ELASTA-clip procedure followed by transapical mitral valve replacement or conventional open MVS were retrospectively analysed. Perioperative and mid-term outcomes including mortality, stroke, bleeding, pacemaker implantation, and the need for mechanical circulatory support were assessed descriptively.ResultsA total of 5 patients were enrolled in the ELASTA group and 31 in the open surgery group, with median follow-up periods of 2 years [IQR: 1.2-2.1] and 1.4 years [IQR: 0.3-3.7], respectively. Procedural success was achieved in all ELASTA cases (100%) compared to 96% in the open surgery group. No in-hospital deaths occurred in the ELASTA group, whereas the surgical group had a mortality rate of 6.5% (n = 2). During follow-up, adverse events occurred in 20% (n = 1) of ELASTA patients and 54.8% (n = 17) of those who underwent surgery.ConclusionsSurgical intervention in patients with failed edge-to-edge mitral valve repair carries a high risk of complications. The ELASTA-clip technique, combined with transapical mitral valve replacement, offers a minimally invasive and safe alternative to conventional surgery, highlighting the need for further prospective studies with longer-term follow-up.

Abstract Cytomegalovirus (CMV), a member of the herpesvirus family, is a common opportunistic infection affecting the global population. Depending on health, economic, and social factors, CMV prevalence ranges between 45% and 100% of the population. While it primarily causes severe complications in immunosuppressed patients, it can also affect immunocompetent individuals, often asymptomatically. Although central nervous system involvement is rare, it can lead to serious complications. Brain abscesses co-infected with CMV are uncommon, and co-infection with Staphylococcus aureus has not been previously reported. Here, we present the case of a 53-year-old immunocompetent male with a history of type 2 diabetes mellitus, endocarditis, and mitral valve replacement surgery, who was admitted to the hospital with left limb weakness. Imaging revealed a brain abscess, and PCR tests confirmed the presence of S. aureus and CMV. This case report discusses the medical management during his hospitalization.

VIRTUAL REALITY PLANNING FOR COMPLEX LATE SEQUELAE IN VALVE SURGERY

Background: Coronary artery disease (CAD) often coexists with valvular heart disease, especially in regions with high prevalence of rheumatic etiology. In developing countries like Pakistan, the clinical presentation of valvular pathology differs significantly from the West, with mitral valve involvement being more common. While CAD screening is routine in developed settings, data on its prevalence in patients undergoing valve replacement surgery in low- to middle-income populations remain scarce, highlighting the need for localized evidence to guide preoperative protocols. Objective: To determine the frequency of angiographically significant CAD in patients undergoing valve replacement surgery and compare its prevalence among patients with and without traditional atherosclerotic risk factors. Methods: This descriptive cross-sectional study was conducted at the National Institute of Cardiovascular Diseases (NICVD), Karachi, over six months. A total of 266 patients aged 40–60 years undergoing aortic, mitral, or double valve replacement surgery were enrolled through consecutive non-probability sampling. Patients with prior CAD, valve surgery, CABG, or PCI were excluded. Detailed history, BMI, socioeconomic data, and risk factor profiles were recorded. Coronary angiography was performed in all patients to identify &gt;70% stenosis in major arteries. Data were analyzed using SPSS v25; associations were tested using chi-square or Fisher’s exact test with a p-value &lt;0.05 as significant. Results: Among 266 participants, 157 (59.0%) were male and 176 (66.2%) resided in urban areas. Mitral valve replacement was the most common procedure (57.5%). Risk factors for atherosclerosis were present in 176 (66.2%) patients. Angiographically significant CAD was identified in 123 (46.2%) patients, with higher prevalence among those with risk factors. Conclusion: The study highlights a high burden of silent but significant CAD in patients undergoing valve replacement, warranting routine coronary evaluation regardless of overt risk factor presence.

Introduction: Severe primary Mitral Regurgitation (MR) is a public health program that continues to grow. Echocardiography is still a tool to assess the severity and prognostic of mitral valve disease. LASr assessment has the benefit of assessing the prognostic in patients who have undergone mitral valve replacement surgery. This study aimed to determine the relationship between LASr and mortality one year after surgery for severe primary MR undergoing valve replacement surgery Methods: This study is an analytic study with a cross-sectional design on 55 subjects with severe primary MR who met the inclusion and exclusion criteria at Haji Adam Malik General Hospital. LASr was measured before surgery and followed by the incidence of mortality one year after mitral valve replacement surgery. Data were analyzed univarite and bivariate as well by correlation tests to assess the relationship between LASr and one-year mortality in severe primary MR undergoing valve replacement surgery Results: The study subject totaled 55 patients with an average age of 39,35 ± 12,59 years, 28 patients (50.9%) were male and 11 patients (20%) experienced mortality. The main cause of mitral valve abnormalities in this study was rheumatic, namely 39 cases (70.9%). The LASr threshold value was found to be 18.8 (sensitivity: 90.9%; specificity: 70.5%). (AUC: 0.851; P = 0.0001 and 95% CI (0.751 – 0.952). Conclusion: LASr has a significant correlation to predict one-year mortality in patients with severe primary mitral regurgitation undergoing mitral valve replacement surgery.

According to the American Association of Poison Control Centers (AAPCC), 761 single exposures to the pharmaceutical warfarin were reported in 2021, accounting for more than 10 percent of anticoagulant cases. The cost and mortality caused by warfarin toxicity are very high and usually incurable and fatal. The most important action in the field of warfarin toxicity is to prevent its occurrence. To emphasize how warfarin toxicity occurs, a case is introduced in this regard. A 61-year-old man is found unconscious with a seizure on the street and transported to the hospital by Emergency Medical Services (EMS). In the emergency car, he received a diazepam injection for generalized seizures. His vital signs in the postictal state were as follows: blood pressure 82/44 mmHg, pulse rate 91 bpm, and oxygen saturation (SaO2) 93%. His past medical history includes an ischemic stroke and a myocardial infarction 12 years ago. He underwent Mitral valve repair 11 years ago and a mechanical-type Mitral valve replacement 2 years ago. After undergoing mitral valve replacement surgery, he continued taking warfarin and aspirin for 2 years without consulting a cardiologist or undergoing PT and INR tests. As a result, he suffered a massive intracerebral hemorrhage when his INR level rose above 6. It's important to note that he has no history of depression or suicide attempts. After experiencing decreased consciousness and seizures, he was quickly intubated. A brain CT scan revealed extensive evidence of intracerebral hemorrhage, and he was then transferred to the operating room for craniotomy. To manage the bleeding and because Prothrombin complex concentrate (PCC) was not available, the patient received two grams of fibrinogen, two units of Fresh Frozen Plasma (FFP), 10 mg of vitamin K, and one unit of Packed Red Blood Cells. Unfortunately, after a month-long stay in the ICU, the patient passed away as a result of Ventilator-associated pneumonia (VAP) and sepsis.

Redo cardiac surgery in patients with cardiac operations is a burden for both the patients and surgeons. Difficulties in exploration and further myocardial damage in recurrent operations are the main issues. Patients with recent operations pose another high-risk group. Herein, we presented two patients, a 67-year-old male and a 45-year-old male, who required mitral valve replacement surgery four weeks after surgical coronary revascularization due to pulmonary edema. The first patient had poor left ventricular functions and was operated on with beating heart surgery with cardiopulmonary bypass via mini anterior thoracotomy. The other patient was operated on with a conventional method.

Cardiac surgery can cause arrhythmias and low cardiac output syndrome through various mechanisms, including cardiac manipulation, systemic inflammation, myocardial hypoxia, cardioplegic arrest, and ischemia resulting from coronary or graft occlusion. Symmetric peripheral gangrene is a rare but serious complication that can occur after cardiac surgery. Here, we present a case of symmetric peripheral gangrene shortly after cardiac surgery for mitral valve replacement. A 76-year-old male with rheumatic heart disease and severe mitral stenosis underwent mitral valve replacement. He experienced postoperative bleeding on the first day after the cardiac surgery. After experiencing ventricular fibrillation, cardiogenic shock, acute hepatic failure, and disseminated intravascular coagulation (DIC), he developed symmetrical peripheral gangrene on the fifth day after cardiac surgery. The patient presented with postoperative bleeding, cardiogenic shock, and DIC complicated by symmetrical peripheral gangrene following cardiac surgery. During cardiosurgery intensive care unit admission, the patient received positive inotropic agents and vasopressors, blood transfusion, and antithrombotic treatment with low -molecular-weight heparin. Because of the severe general condition of the patient, amputation was not performed. The patient died on the 80th day after cardiac surgery because of multiorgan failure and DIC. Physicians should be vigilant for comorbid symmetrical peripheral gangrene in patients undergoing cardiac surgery who present with postoperative bleeding, cardiogenic shock, and DIC. Early recognition of acrocyanosis, prompt management of cardiogenic shock, correction of anemia, hemodynamic stabilization, and properly controlled use of anticoagulation may help prevent symmetrical peripheral gangrene.

Systemic lupus erythematosus (SLE) is an autoimmune disorder that leads to immune dysregulation and increased infection risk, especially with immunosuppressive therapies and surgical interventions like splenectomy. Immune monitoring in these patients is important. This case report aims to describe the immune changes in an SLE patient, who had received splenectomy, with infective endocarditis (IE) undergoing valve replacement surgery, focusing on immune cell dynamics and exhaustion markers. A 42-year-old Taiwanese man with SLE and recent splenectomy was diagnosed with IE caused by Staphylococcus aureus, requiring mitral valve replacement surgery. Immune profiling between infection and recover phase showed immune regulation and reconstruction with increased exhaustion markers (killer cell lectin-like receptor subfamily G member 1 (KLRG1), T-cell immunoglobulin and mucin-domain containing-3 (Tim-3), programmed cell death protein 1 (PD-1)) in T cells, expanded regulatory T cells, increased plasmablasts, and decreased regulatory B cells. SLE leads to significant immune dysregulation, making patients more susceptible to infections, especially when combined with immunosuppressive therapy. This case demonstrates dynamic changes in immune markers, such as KLRG1, Tim-3, and PD-1, following infection and surgery, highlighting the necessary for monitoring of immune function in SLE patients. Changes in T and B cell component emphasize the importance of tailored treatment strategies to keep immune imbalances in these patients. Ongoing research into immune tolerance and exhaustion mechanisms will be crucial for improving therapeutic outcomes in SLE.

We present a technique for mitral valve (MV) replacement that preserves the anterior mitral leaflet (AML) using complete chordal-sparing mitral valve replacement (CCS-MVR), which maintains the architecture of the left ventricle. This technique is beneficial for patients with functional, degenerative, and infective MV disease who were unable to undergo MV repair. The objective of this study is to ascertain the most efficacious treatment for MV disease. Furthermore, the study will contribute to international guidelines for this procedure and provide data on its efficacy in treating MV disease. We performed MV replacement surgery on 161 patients, maintaining the integrity of the entire subvalvular chordae tendineae apparatus. Of these cases, 92 (57.1%) were degenerative, 58 (36.0%) were functional, 9 (5.6%) were infective, and 2 (1.2%) were rheumatic. Of the 93 patients with complicated MV disease, massive calcification was observed in 59 cases (36.6%) and mitral annular disjunction (MAD) was observed in 25 cases (15.5%) while endocarditis with posterior annular abscess was observed in 9 cases (5.6%). The anterior leaflet is detached from its connection to the annulus along the entire extent from the posterior commissure to the anterior commissure. In cases of excess tissue, a section of the free edge of the translocated leaflet must be removed. This must preserve a small section of the edge and the entire chordae tendineae unit. A CCS-MVR requires 24 to 28 individual sutures in routine cases. The AML was reinserted using 12 to 14 single sutures in this specific order: posterior annulus, posterior mitral leaflet, AML, and prosthetic valve. The 30-day mortality rate was 8.7%, based on 14 cases. Ten patients, representing 5% of the total, required reoperation after the initial procedure. Out of 140 patients,74 (52.8%) experienced LV reverse remodeling at the six-month follow-up. Female patients exhibited a significantly higher rate of LV reverse remodeling (71% vs. 29%, P<0.001) compared to male patients. Patients with mitral annular calcification and MAD demonstrated significantly higher rates of left ventricular reverse remodeling compared to patients with coronary artery disease (CAD). We can conclude with certainty that male gender, CAD, atrial fibrillation, and preoperative left ventricular end-diastolic volume indexed (LVEDVI) are significant predictors of LV remodeling. We found that the median survival time after CCS-MVR was 39.5 months. The results of the multivariable analysis revealed that patients with MAD had significantly worse survival rates than those without. For patients presenting with severely calcified posterior mitral annulus, complicated Barlow disease with MAD, or endocarditis involving the posterior annulus, the AML is consolidated with the posterior mitral leaflet to form a neo-annulus. This procedure is safe and effective for a wide range of simple and complex MV pathologies. Its efficacy is unquestionable. It preserves the complete architecture of the left ventricle, avoiding dilatation and promoting reverse remodeling.

Background: The efficacy of manual carotid artery compression in reducing cerebral embolization during cardiac surgeries is a topic of debate. Aim: This study aimed to assess the safety and efficacy of carotid artery compression in preventing postoperative cognitive dysfunction (POCD) in patients undergoing mitral valve replacement surgery. Methodology: This randomized, double-blind, parallel-group clinical trial enrolled 120 adult patients scheduled for mitral valve replacement surgery. The patients were randomly assigned to two groups of 60 patients each. Group C underwent carotid artery compression using three fingers (index, middle, and ring fingers) along the path of the artery for 20 seconds following aortic declamping, while group NC did not undergo carotid artery compression. The study's primary outcome was the incidence rate of POCD at 5-7 days and the Mini-Mental State Examination score. Secondary outcomes included the incidence rate of POCD after 6 weeks postoperatively and transcranial Doppler readings. Results: The incidence rates of POCD at 5-7 days and after 6 weeks postoperatively were comparable in both groups (p=0.163 and 0.364, respectively). Additionally, the Mini-Mental State Examination score and transcranial Doppler results were comparable between the groups before and after surgery. The incidence of cognitive dysfunction in the NC group at 5 days postoperatively was significantly associated with older age, shorter surgical duration, and reduced middle cerebral artery velocity by transcranial Doppler.Conclusion: Carotid artery compression does not prevent cognitive dysfunction after mitral valve replacement surgery. However, no additional harm is associated with carotid compression.