Perioperative Strokes and Early Outcomes in Mitral Valve Surgery: A Nationwide Analysis

Udesh, Reshmi; Mehta, Amol; Gleason, Thomas G.; Wechsler, Lawrence R.

doi:10.1053/j.jvca.2016.12.006

Cited by 16 publications

(11 citation statements)

References 35 publications

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“…Risk factors for perioperative stroke include conventional vascular risk factors (i.e., age, sex, or a history of stroke or transient ischemic attack), the type of surgery (i.e., cardiovascular surgery or neurosurgery), or specific intraoperative events. Among patients who underwent mitral valve surgery, the factors associated with perioperative stroke were as follows: age, sex, emergency surgery, arrhythmias, hypertension, renal failure, coagulopathy, neurological disorders, weight loss, anemia, postoperative cardiac arrest, and myocardial infarction [ 20 ]. These risk factors can be categorized into modifiable or non-modifiable factors.…”

Section: Risk Factorsmentioning

confidence: 99%

Perioperative stroke: pathophysiology and management

2018

Korean J Anesthesiol

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Although perioperative stroke is uncommon during low-risk non-vascular surgery, if it occurs, it can negatively impact recovery from the surgery and functional outcome. Based on the Society for Neuroscience in Anesthesiology and Critical Care Consensus Statement, perioperative stroke includes intraoperative stroke, as well as postoperative stroke developing within 30 days after surgery. Factors related to perioperative stroke include age, sex, a history of stroke or transient ischemic attack, cardiac surgery (aortic surgery, mitral valve surgery, or coronary artery bypass graft surgery), and neurosurgery (external carotid-internal carotid bypass surgery, carotid endarterectomy, or aneurysm clipping). Concomitant carotid and cardiac surgery may further increase the risk of perioperative stroke. Preventive strategies should be individualized based on patient factors, including cerebrovascular reserve capacity and the time interval since the previous stroke.

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Section: Risk Factorsmentioning

confidence: 99%

Perioperative stroke: pathophysiology and management

2018

Korean J Anesthesiol

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“…32,33 Both stroke and the other less severe, but much more frequent, forms of cerebral injury after cardiac surgery, namely delirium and postoperative cognitive dysfunction (POCD), are associated with worsened short-and long-term outcomes, including hospital LOS and mortality. 10, [32][33][34]36 Although there is some evidence that volatile anesthetics may 1-5 10,33 4.8 32,33 3.9-8.9 23,33 6.9 26 POCD (short-term) 20-50 34 exert a protective action not only against myocardial injury but also against cerebral ischemia, 49 the etiology of POCD and delirium, which is substantially unknown, is probably multifactorial and may be linked, at least in part, to anesthetic drugs and anesthesia depth. 50,51 Almost all patients undergoing cardiac surgery show some degree of respiratory function impairment during the first few days after the intervention.…”

Section: Mortality and Major Complications After Cardiac Surgerymentioning

confidence: 99%

The Impact of Anesthetic Regimen on Outcomes in Adult Cardiac Surgery: A Narrative Review

Pisano

Torella

Yavorovskiy

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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“…The same association between the degree of CKD and adverse outcomes was noted in patients undergoing TAVR [ 49 ]. Eventually, this was found to be applicable to patients undergoing mitral valve repair as well, and baseline CKD was implicated in predicting poor outcomes [ 50 , 51 ]. Addressing long-term outcomes in relation to CKD specific to volume status, a retrospective study involving patients with advanced heart failure and functional MR who underwent surgical mitral valve repair, found that patients with End-Stage Renal Disease (ESRD) on hemodialysis had more favorable outcomes in terms of mortality and readmissions for heart failure exacerbations compared to those with late-stage CKD, not on hemodialysis.…”

Section: Chronic Kidney Disease As a Predictor Of Poor Outcomes Post mentioning

confidence: 99%

“…The presence of CKD at baseline in patients undergoing mitral valve repair has an adverse impact on long-term outcomes, regardless of the degree of improvement in GFR post repair [43][44][45]. The strong association between heart failure and CKD is well known, and conceivably the presence of CKD in heart failure was also found to be associated with increased mortality [46].…”

Section: Chronic Kidney Disease As a Predictor Of Poor Outcomes Post Mitral Valve Re-pairmentioning

confidence: 99%

Interrelationship Between Kidney Function and Percutaneous Mitral Valve Interventions: A Comprehensive Review

Dayanand

Ram

et al. 2019

CCR

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Percutaneous mitral valve repair is emerging as a reasonable alternative especially in those with an unfavorable surgical risk profile in the repair of mitral regurgitation. At this time, our understanding of the effects of underlying renal dysfunction on outcomes with percutaneous mitral valve repair and the effects of this procedure itself on renal function is evolving, as more data emerges in this field. The current evidence suggests that the correction of mitral regurgitation via percutaneous mitral valve repair is associated with some degree of improvement in cardiac function, hemodynamics and renal function. The improvement in renal function was more significant for those with greater renal dysfunction at baseline. The presence of Chronic Kidney Disease (CKD) in turn has been associated with poor long-term outcomes including increased mortality and hospitalization among patients who undergo percutaneous mitral valve repair. This was true regardless of the degree of improvement in GFR post repair advanced CKD. The adverse impact of CKD on long-term outcomes was consistent across all studies and was more prominent in those with GFR<30 mL/min/1.73 m². It is clear that from these contrasting evidences of improved renal function post mitral valve repair but poor long-term outcomes including increased mortality in patients with CKD, that proper patient selection for percutaneous mitral valve repair is key. There is a need to have better-standardized criteria for patients who should qualify to have percutaneous mitral valve replacement with Mitraclip. In this new era of percutaneous mitral valve repair, much work needs to be done to optimize long-term patient outcomes.

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Perioperative Strokes and Early Outcomes in Mitral Valve Surgery: A Nationwide Analysis

Cited by 16 publications

References 35 publications

Perioperative stroke: pathophysiology and management

Perioperative stroke: pathophysiology and management

The Impact of Anesthetic Regimen on Outcomes in Adult Cardiac Surgery: A Narrative Review

Interrelationship Between Kidney Function and Percutaneous Mitral Valve Interventions: A Comprehensive Review

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