Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Semin Thorac Cardiovasc Surg. 2020 Spring;32(1):47-56. doi: 10.1053/j.semtcvs.2019.09.001. Epub 2019 Sep 23.
Minimally invasive mitral valve surgery (mini-MVS) with hypothermic fibrillatory arrest has been associated with an increased risk of stroke. We aim to investigate the incidence, predictors, and outcomes of stroke in a large cohort of patient who underwent clampless mini-MVS. Between January 2008 and June 2017, we performed 1247 mini-MVSs. The clinical, operative, and postoperative outcomes were analyzed. Univariable and multivariable regression analyses were used to identify predictors of postoperative stroke. The median follow-up was 5.2 years (interquartile range 2.6-7.5). The etiology of mitral valve (MV) disease was degenerative (60.4%, n = 753), functional (12.8%, n = 160), rheumatic (8.7%, n = 109), endocarditis (3.1%, n = 39), and reoperative MV surgery (14.9%, n = 186). The overall incidence of postoperative neurologic event was 2.5% (n = 31/1247). Univariable predictors of stroke were a higher Society of Thoracic Surgeons mortality risk (6.0 ± 11.8% vs 3.3 ± 5.2%, P < 0.001), advanced age, (69.6 ± 12.1 years vs 63.0 ± 13.6 years, P = 0.002), female gender (71.0% vs 46.3%, P = 0.007), and a history of a cerebrovascular accident (22.6% vs 8.7%, P = 0.008). Stroke patients had a higher 30-day mortality (22.6% vs 1.6%, P < 0.001) and a higher risk for long-term mortality (hazard ratio = 5.56, 95% confidence interval [CI] 3.2-9.6, P < 0.001). Advanced age (odds ratio [OR] 2.1; 95% CI 1.1-4.0; P = 0.02), female gender (OR 2.3; 95% CI 0.9-5.2; P = 0.05), and history of cerebrovascular accident (OR 3.1; 95% CI 0.98-10.1; P = 0.05) remained as independent predictors of stroke in the multivariable analysis. Our decade-long experience indicates that clampless mini-MVS is associated with a low incidence of postoperative stroke, and that the predictors of stroke are not specific to this approach.
低温颤搐停搏下的微创二尖瓣手术（mini-MVS）与中风风险增加相关。我们旨在调查在接受无夹心法 mini-MVS 的大量患者中中风的发生率、预测因素和结局。
在 2008 年 1 月至 2017 年 6 月期间，我们进行了 1247 例 mini-MVS。分析了临床、手术和术后结果。使用单变量和多变量回归分析来确定术后中风的预测因素。中位随访时间为 5.2 年（四分位距 2.6-7.5）。二尖瓣（MV）疾病的病因是退行性（60.4%，n=753）、功能性（12.8%，n=160）、风湿性（8.7%，n=109）、心内膜炎（3.1%，n=39）和再次二尖瓣手术（14.9%，n=186）。术后神经系统事件的总发生率为 2.5%（n=31/1247）。中风的单变量预测因素包括更高的胸外科医生死亡率风险（6.0±11.8%比 3.3±5.2%，P<0.001）、高龄（69.6±12.1 岁比 63.0±13.6 岁，P=0.002）、女性（71.0%比 46.3%，P=0.007）和中风史（22.6%比 8.7%，P=0.008）。中风患者的 30 天死亡率更高（22.6%比 1.6%，P<0.001），长期死亡率风险更高（风险比=5.56，95%置信区间[CI]3.2-9.6，P<0.001）。高龄（优势比[OR]2.1；95%CI 1.1-4.0；P=0.02）、女性（OR 2.3；95%CI 0.9-5.2；P=0.05）和中风史（OR 3.1；95%CI 0.98-10.1；P=0.05）在多变量分析中仍然是中风的独立预测因素。
我们长达十年的经验表明，无夹心法 mini-MVS 与术后中风发生率低相关，并且中风的预测因素并非特定于该方法。
