THE RISK OF STROKE IN THE EARLY POSTOPERATIVE PERIOD FOLLOWING MITRAL-VALVE REPLACEMENT

All patients (285) undergoing mitral valve replacement (MVR) with a Ca rpentier-Edwards (C-E) bioprosthesis +/- coronary bypass grafts (CABG) were reviewed (109 men and 176 women with a median age of 70 years). Overall, the 5-year survival rate was 58.9 %, 62.7 % for MVR (199 pati ents) and 50.1 % for MVR + CABG (86 patients), Late survival was adver sely affected by the operative time variables of NYHA class IV, older (greater than or equal to 70 years) age, low (greater than or equal to 56 %) ejection fraction (EF), and the additional performance of assoc iated procedures + CABG with MVR (P less than or equal to 0.001), The 5-year freedom from stroke rate was 89.2 %, 89.1 % for MVR and 90.2% f or MVR +/- CABG, Advanced heart class was the only significant variabl e associated with a greater risk of late stroke (PI 0.01), Neither chr onic preoperative atrial fibrillation nor operative obliteration of th e left atrial appendage increased or decreased the late risk of stroke in patients following MVR, Hazard function for stroke occurring in th e first postoperative year (first 48 h excluded to discount intraopera tive events) demonstrated the highest rate within the first month (40 %), rapidly diminishing thereafter. This pattern was reproduced in the 12-year hazard function in that the rate of stroke occurrence was gre atest in the first year (6.7 %) following implantation, The mean strok e rate over 12 years was 2.5 %. Strokes following MVR +/- CABG are mor e likely to occur in older and more compromised patients, and the high er early rate is not reflected in the mean rate, A more aggressive app roach to early anticoagulation with IV heparin, Coumadin, and possibly antiplatelet therpay is advocated to reduce this complication rate.