Thiagarajan Karthy, Jeevanantham Vinodh, Van Ham Raymond, Gleason Thomas G, Badhwar Vinay, Chang YueFang, Thirumala Parthasarathy D
Departments of *Neurological Surgery §Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh Medical Center ‡University of Pittsburgh School of Medicine, Pittsburgh, PA †Saint Anthony Hospital, Oklahoma City, OK ∥Division of Cardiothoracic Surgery, West Virginia University, Morgantown, WV.
Neurologist. 2017 Nov;22(6):227-233. doi: 10.1097/NRL.0000000000000151.
Perioperative stroke rate after surgical aortic valve replacement (SAVR) varies between 1.3% and 6.2%, whereas the operative mortality ranges between 1% and 16.4%. The aim of this study was to determine whether perioperative stroke is a risk factor for operative mortality after SAVR by performing a meta-analysis of relevant studies.
PubMed, EMBASE, and Web of Science databases were searched to retrieve relevant literature. Screening of the articles was done independently on the basis of predetermined criteria. Data from the relevant studies were extracted and a random effects model was used to calculate the odds of mortality among patients with perioperative strokes after aortic valve replacement compared with those without such strokes. Subgroup analyses of patients (1) aged above and below 70 years and (2) undergoing isolated valve replacement procedure were performed. Metaregression to check for association of effect estimate and (1) sex, (2) mechanical valve replacement, (3) New York Heart Association class III/IV, (4) left ventricle ejection fraction <30%, and (5) preoperative atrial fibrillation was performed.
Statistical analyses using a random effects model showed that patients with perioperative strokes had 4.74 times greater odds for operative mortality after SAVR, independent of the following covariates: (1) sex, (2) mechanical valve replacement, (3) New York Heart Association class III/IV, (4) left ventricle ejection fraction <30%, and (5) preoperative atrial fibrillation.
Patients with perioperative strokes after SAVR have nearly 5 times greater odds of experiencing operative mortality compared with those without. Thus, perioperative strokes are associated with increased risk of early mortality and require further examination of preventive strategies.
外科主动脉瓣置换术（SAVR）后围手术期卒中发生率在1.3%至6.2%之间，而手术死亡率在1%至16.4%之间。本研究的目的是通过对相关研究进行荟萃分析，确定围手术期卒中是否是SAVR后手术死亡率的危险因素。
检索PubMed、EMBASE和Web of Science数据库以获取相关文献。根据预定标准独立进行文章筛选。提取相关研究的数据，并使用随机效应模型计算主动脉瓣置换术后发生围手术期卒中的患者与未发生此类卒中的患者相比的死亡几率。对患者进行亚组分析：（1）年龄在70岁以上和以下；（2）接受单纯瓣膜置换手术。进行元回归以检查效应估计值与以下因素的关联：（1）性别；（2）机械瓣膜置换；（3）纽约心脏协会III/IV级；（4）左心室射血分数<30%；（5）术前心房颤动。
使用随机效应模型进行的统计分析表明，围手术期卒中患者在SAVR后手术死亡的几率是未发生围手术期卒中患者的4.74倍，与以下协变量无关：（1）性别；（2）机械瓣膜置换；（3）纽约心脏协会III/IV级；（4）左心室射血分数<30%；（5）术前心房颤动。
与未发生围手术期卒中的患者相比，SAVR后发生围手术期卒中的患者手术死亡几率高出近5倍。因此，围手术期卒中与早期死亡风险增加相关，需要进一步研究预防策略。
