{
  "abstract": "BACKGROUND: Increasing use of mitral valve repair has shifted operations to older patients, potentially increasing the post-repair thromboembolic risk. However, the incidence, timing, and determinants of ischemic stroke/transient ischemic attack (TIA) after mitral repair in patients without preoperative atrial fibrillation (AF) remain undetermined. METHODS AND RESULTS: We retrospectively analyzed 636 patients (mean age, 58±13 years) with degenerative mitral regurgitation and sinus rhythm who underwent mitral valve repair. The primary endpoint was stroke/TIA. Over a mean follow-up of 7.4±5.5 years (4,681 patient-years), 28 (4.4%) developed stroke/TIA. Incidence peaked in the first postoperative year (1.4%/year), declined thereafter, and rose again at 10-15 years (0.67%/year). New-onset AF occurred in 54 patients (8.4%), based on 3,119 ECGs (mean, 4.9±5.8 per patient). Early events (≤1 year) rather than late events (>1 year) occurred in older patients (early vs. late events: 72±8.8 vs. 62±13 years, P=0.052). Later events were associated with larger left atrial size (48±6.7 vs. 41±7.6 mm, P=0.016) and a higher prevalence of new-onset AF (58% vs. 11%, P=0.039). Age ≥70 years (adjusted hazard ratio (HR), 4.4; P<0.001), new-onset AF (adjusted HR, 4.0; P<0.001) and NYHA class (adjusted HR: 2.0, P=0.02) were identified by Fine-Gray regression as independent determinants of stroke/TIA. CONCLUSIONS: After mitral repair, ischemic stroke/TIA occurred in 4.4% of patients without preoperative AF, associated with advanced age, new-onset AF, and higher NYHA functional class. This supports close rhythm surveillance and heart failure management.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 19,
  "authors": [
    {
      "name": "Rieko Kutsuzawa"
    },
    {
      "name": "Satoshi Kainuma"
    },
    {
      "name": "Naonori Kawamoto"
    },
    {
      "name": "Kizuku Yamashita"
    },
    {
      "name": "Kota Suzuki"
    },
    {
      "name": "Takashi Kakuta"
    },
    {
      "name": "Ayumi Ikuta"
    },
    {
      "name": "Shinichi Kurashima"
    },
    {
      "name": "Yuki Irie"
    },
    {
      "name": "Kenji Moriuchi"
    },
    {
      "name": "Masashi Amano"
    },
    {
      "name": "Atsushi Okada"
    },
    {
      "name": "Makoto Amaki"
    },
    {
      "name": "Hideaki Kanzaki"
    },
    {
      "name": "Takeshi Kitai"
    },
    {
      "name": "Chisato Izumi"
    },
    {
      "name": "Kazuhiro Yamamoto"
    },
    {
      "name": "Takashi Daimon"
    },
    {
      "name": "Satsuki Fukushima"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/d83f64mz1t6xz.bib",
  "cited_by": 0,
  "doi": "10.1253/circj.cj-26-0035",
  "fulltext_url": "https://www.jstage.jst.go.jp/article/circj/90/9/90_CJ-26-0035/_article",
  "id": "d83f64mz1t6xz",
  "issns": [
    "1347-4820",
    "1346-9843"
  ],
  "landing_url": "https://www.jstage.jst.go.jp/article/circj/90/9/90_CJ-26-0035/_article",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "jstage-journal",
      "medicine/cardiovascular"
    ],
    [
      "openalex",
      "2705|Cardiac Valve Diseases and Treatments"
    ]
  ],
  "openalex": "W7163583333",
  "pdf_url": "https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-26-0035/_pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-08-25",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/d83f64mz1t6xz.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:24Z",
      "native_id": "10.1253/circj.cj-26-0035",
      "source": "jstage",
      "url": "https://www.jstage.jst.go.jp/article/circj/90/9/90_CJ-26-0035/_article"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Cardiac Valve Diseases and Treatments",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Incidence, Timing, and Determinants of Stroke After Mitral Repair in Patients Without Preoperative Atrial Fibrillation",
  "title_text": "Incidence, Timing, and Determinants of Stroke After Mitral Repair in Patients Without Preoperative Atrial Fibrillation",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:24Z",
  "url": "https://research.draconitic.com/paper/d83f64mz1t6xz",
  "venue": "Circulation Journal",
  "versions": []
}