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Perioperative Stroke and Mortality After Surgical Aortic Valve Replacement: A Meta-Analysis

Thiagarajan, Karthy MBBS*; Jeevanantham, Vinodh MD; Van Ham, Raymond BS; Gleason, Thomas G. MD, FACS, FACC, FACCP§; Badhwar, Vinay MD; Chang, YueFang PhD*; Thirumala, Parthasarathy D. MD, MS*,‡

doi: 10.1097/NRL.0000000000000151
Review Article

Objective: 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.

Materials and Methods: 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.

Results: 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.

Conclusions: 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.

Supplemental Digital Content is available in the text.

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

The authors declare no conflict of interest.

Reprints: Parthasarathy D. Thirumala, MD, MS, Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, PUH B-400, Pittsburgh, PA 15213. E-mail:

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