Hypothermic fibrillatory arrest may not increase stroke risk in minimally invasive mitral valve surgery: A 13-year propensity score-matched experience.
- 1Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tenn.
- 2Vanderbilt University School of Medicine, Nashville, Tenn.
Abstract
Objectives
Hypothermic fibrillatory arrest (HFA) has been associated with increased stroke risk in minimally invasive mitral valve surgery, although selection bias may confound this association.Methods
We performed a single-center retrospective analysis of minimally invasive mitral valve surgeries (July 2011 to December 2024) stratified by myocardial protection strategy (HFA vs aortic crossclamping [ACC]), assessed using propensity-score matching and multivariable logistic regression.Results
Of 1258 patients, 984 underwent HFA and 274 received ACC. The fibrillatory arrest group had more complex profiles and greater rates of previous myocardial infarction (14.2% vs 4.7%), previous cardiac surgery (12.8% vs 2.2%), and urgent/emergent status (18.8% vs 10.2% all P < .05). Despite these greater-risk profiles, postoperative stroke rates were comparable (3.1% vs 3.7%, P = .57). After propensity matching, stroke remained comparable (3.3% vs 3.7%), and fibrillatory arrest was not independently associated with increased stroke risk (odds ratio, 0.94; P = .91). In-hospital mortality was also comparable (HFA: 2.6% vs ACC: 1.5%).Conclusions
HFA demonstrated noninferior stroke outcomes compared with ACC when performed with meticulous protocols at high-volume centers. These findings do not support HFA as a replacement for ACC but rather as a viable alternative when clinically and technically indicated.
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BibTeX
@article{ahmad2026hypothermic,
title = {{Hypothermic fibrillatory arrest may not increase stroke risk in minimally invasive mitral valve surgery: A 13-year propensity score-matched experience.}},
author = {Awab Ahmad and Christian Eidson and Walter Navid and Emma Stimpfl and Chen Chia Wang and Mark Petrovic and Aaron M Williams and John Trahanas and Swaroop Bommareddi and Eric Quintana and Brian Lima and Ashish S Shah and Tarek Absi},
journal = {JTCVS open},
year = {2026},
month = aug,
doi = {10.1016/j.xjon.2026.102054},
url = {https://europepmc.org/article/MED/42948508},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Hypothermic fibrillatory arrest may not increase stroke risk in minimally invasive mitral valve surgery: A 13-year propensity score-matched experience.
AU - Awab Ahmad
AU - Christian Eidson
AU - Walter Navid
AU - Emma Stimpfl
AU - Chen Chia Wang
AU - Mark Petrovic
AU - Aaron M Williams
AU - John Trahanas
AU - Swaroop Bommareddi
AU - Eric Quintana
AU - Brian Lima
AU - Ashish S Shah
AU - Tarek Absi
PY - 2026
DA - 2026/08/22
JO - JTCVS open
DO - 10.1016/j.xjon.2026.102054
UR - https://europepmc.org/article/MED/42948508
AB - Objectives Hypothermic fibrillatory arrest (HFA) has been associated with increased stroke risk in minimally invasive mitral valve surgery, although selection bias may confound this association.Methods We performed a single-center retrospective analysis of minimally invasive mitral valve surgeries (July 2011 to December 2024) stratified by myocardial protection strategy (HFA vs aortic crossclamping [ACC]), assessed using propensity-score matching and multivariable logistic regression.Results Of 1258 patients, 984 underwent HFA and 274 received ACC. The fibrillatory arrest group had more complex profiles and greater rates of previous myocardial infarction (14.2% vs 4.7%), previous cardiac surgery (12.8% vs 2.2%), and urgent/emergent status (18.8% vs 10.2% all P < .05). Despite these greater-risk profiles, postoperative stroke rates were comparable (3.1% vs 3.7%, P = .57). After propensity matching, stroke remained comparable (3.3% vs 3.7%), and fibrillatory arrest was not independently associated with increased stroke risk (odds ratio, 0.94; P = .91). In-hospital mortality was also comparable (HFA: 2.6% vs ACC: 1.5%).Conclusions HFA demonstrated noninferior stroke outcomes compared with ACC when performed with meticulous protocols at high-volume centers. These findings do not support HFA as a replacement for ACC but rather as a viable alternative when clinically and technically indicated.
SN - 2666-2736
ER -