Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Risk of neurologic events after surgery for mitral valve insufficiency and concomitant Cox-maze IV procedure for atrial fibrillation. A nationwide register-based study

Albåge, Anders ; Vanky, Farkas ; Boano, Gabriella ; Holmgren, Anders ; Jidéus, Lena ; Johansson, Birgitta ; Kennebäck, Göran ; Nozohoor, Shahab LU orcid ; Scherstén, Henrik and Sjögren, Johan LU , et al. (2024) In Interdisciplinary Cardiovascular and Thoracic Surgery 39(6).
Abstract

OBJECTIVES: Analysis of the long-term risks of ischaemic stroke and cerebral bleeding in patients with atrial fibrillation after mitral valve surgery and concomitant Cox-maze IV procedure. METHODS: In total, 397 patients with symptomatic degenerative mitral valve insuffciency and atrial fibrillation, underwent mitral valve surgery and Cox-maze IV in Sweden between 2009 and 2017. In this retrospective nationwide analysis, patients were followed in national patient registers until 30 September 2022. RESULTS: There were 4 deaths within 30 days (1.0%). Mean follow-up was 8.7 (0.1–13.4) years. Survival without ischaemic stroke or cerebral haemorrhage at 5 and 10 years were 90% and 74%, respectively. Nineteen patients experienced an ischaemic... (More)

OBJECTIVES: Analysis of the long-term risks of ischaemic stroke and cerebral bleeding in patients with atrial fibrillation after mitral valve surgery and concomitant Cox-maze IV procedure. METHODS: In total, 397 patients with symptomatic degenerative mitral valve insuffciency and atrial fibrillation, underwent mitral valve surgery and Cox-maze IV in Sweden between 2009 and 2017. In this retrospective nationwide analysis, patients were followed in national patient registers until 30 September 2022. RESULTS: There were 4 deaths within 30 days (1.0%). Mean follow-up was 8.7 (0.1–13.4) years. Survival without ischaemic stroke or cerebral haemorrhage at 5 and 10 years were 90% and 74%, respectively. Nineteen patients experienced an ischaemic stroke, of which 4 were fatal. Five of 34 patients (14.7%) with a history of stroke preoperatively experienced ischaemic stroke during follow-up. The linearized rate of ischaemic stroke per patient-year was 0.6% and was similar regardless of left atrial appendage closure during surgery or whether a mechanical valve was inserted. The observed ischaemic stroke rate was lower than the predicted rate for all CHA2DS2-VASc score groups. Fourteen patients suffered cerebral bleeding, of which 3 were fatal. Patients who experienced cerebral bleeding were older and had higher mechanical valve implantation rate than those without cerebral bleeding. CONCLUSIONS: Surgery for mitral valve insufficiency and concomitant Cox-maze IV can be performed with low perioperative risk. There is a low continuing risk of stroke long-term postoperatively that correlates with a higher CHA2DS2-VASc score. Patients with preoperative stroke are at increased risk of postoperative stroke despite atrial fibrillation surgery.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and , et al. (More)
; ; ; ; ; ; ; ; ; ; and (Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Atrial fibrillation, Cerebral bleeding, Cox-maze IV, Stroke
in
Interdisciplinary Cardiovascular and Thoracic Surgery
volume
39
issue
6
article number
ivae189
publisher
Oxford University Press
external identifiers
  • pmid:39558628
  • scopus:85212115191
DOI
10.1093/icvts/ivae189
language
English
LU publication?
yes
id
e86dfa0f-3b05-4c04-aae4-7ede71bd07e5
date added to LUP
2025-01-20 11:28:25
date last changed
2025-11-25 13:14:49
@article{e86dfa0f-3b05-4c04-aae4-7ede71bd07e5,
  abstract     = {{<p>OBJECTIVES: Analysis of the long-term risks of ischaemic stroke and cerebral bleeding in patients with atrial fibrillation after mitral valve surgery and concomitant Cox-maze IV procedure. METHODS: In total, 397 patients with symptomatic degenerative mitral valve insuffciency and atrial fibrillation, underwent mitral valve surgery and Cox-maze IV in Sweden between 2009 and 2017. In this retrospective nationwide analysis, patients were followed in national patient registers until 30 September 2022. RESULTS: There were 4 deaths within 30 days (1.0%). Mean follow-up was 8.7 (0.1–13.4) years. Survival without ischaemic stroke or cerebral haemorrhage at 5 and 10 years were 90% and 74%, respectively. Nineteen patients experienced an ischaemic stroke, of which 4 were fatal. Five of 34 patients (14.7%) with a history of stroke preoperatively experienced ischaemic stroke during follow-up. The linearized rate of ischaemic stroke per patient-year was 0.6% and was similar regardless of left atrial appendage closure during surgery or whether a mechanical valve was inserted. The observed ischaemic stroke rate was lower than the predicted rate for all CHA<sub>2</sub>DS<sub>2</sub>-VASc score groups. Fourteen patients suffered cerebral bleeding, of which 3 were fatal. Patients who experienced cerebral bleeding were older and had higher mechanical valve implantation rate than those without cerebral bleeding. CONCLUSIONS: Surgery for mitral valve insufficiency and concomitant Cox-maze IV can be performed with low perioperative risk. There is a low continuing risk of stroke long-term postoperatively that correlates with a higher CHA<sub>2</sub>DS<sub>2</sub>-VASc score. Patients with preoperative stroke are at increased risk of postoperative stroke despite atrial fibrillation surgery.</p>}},
  author       = {{Albåge, Anders and Vanky, Farkas and Boano, Gabriella and Holmgren, Anders and Jidéus, Lena and Johansson, Birgitta and Kennebäck, Göran and Nozohoor, Shahab and Scherstén, Henrik and Sjögren, Johan and Wickbom, Anders and Ivert, Torbjörn}},
  keywords     = {{Atrial fibrillation; Cerebral bleeding; Cox-maze IV; Stroke}},
  language     = {{eng}},
  number       = {{6}},
  publisher    = {{Oxford University Press}},
  series       = {{Interdisciplinary Cardiovascular and Thoracic Surgery}},
  title        = {{Risk of neurologic events after surgery for mitral valve insufficiency and concomitant Cox-maze IV procedure for atrial fibrillation. A nationwide register-based study}},
  url          = {{http://dx.doi.org/10.1093/icvts/ivae189}},
  doi          = {{10.1093/icvts/ivae189}},
  volume       = {{39}},
  year         = {{2024}},
}