Minimally Invasive Aortic Valve Replacement and Perioperative Stroke Risk: A Propensity-Matched Analysis
- 1Department of Cardiac Surgery, Upper-Silesian Heart Center, 40-635 Katowice, Poland
- 2Department of Cardiac Surgery, Medical University of Silesia, 40-055 Katowice, Poland
Abstract
Background/Objectives: Stroke is a devastating complication after aortic valve replacement (AVR). Whether minimally invasive AVR (miniAVR) reduces perioperative stroke risk versus conventional sternotomy remains uncertain. Methods: This single-center retrospective cohort study used propensity score matching (PSM) in 1741 consecutive patients undergoing isolated AVR (2014–2025). After exclusions, 1:1 PSM using 10 covariates created 155 matched pairs with excellent balance (all standardized mean differences < 0.20). The primary endpoint was in-hospital stroke or transient ischemic attack (TIA); secondary endpoints were 30-day and 5-year mortality and major complications. Firth penalized logistic regression identified independent predictors of stroke/TIA. Results: Stroke/TIA occurred in 0/155 (0.0%) miniAVR versus 7/155 (4.5%) conventional patients (p = 0.015); the rule-of-three upper 95% limit for miniAVR was ~1.9%. Thirty-day mortality was similar (0.6% vs. 2.6%; p = 0.371). Five-year survival favored miniAVR (94.6% vs. 87.2%; log-rank p = 0.047). miniAVR was independently associated with lower stroke/TIA odds (odds ratio [OR] 0.052; 95% confidence interval [CI] 0.003–0.832; p = 0.037); longer cardiopulmonary bypass time was associated with higher odds (OR 1.014/minute; 95% CI 1.001–1.028; p = 0.032). Conclusions: miniAVR was associated with zero observed perioperative strokes and higher 5-year survival; however, this survival comparison is limited by short median follow-up in the miniAVR group (1.9 years). Given the small number of events and the single-center design, these findings should not be interpreted as proof of a causal neuroprotective effect. Multicenter validation with longer, balanced follow-up is required.
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BibTeX
@article{kowalowka2026minimally,
title = {{Minimally Invasive Aortic Valve Replacement and Perioperative Stroke Risk: A Propensity-Matched Analysis}},
author = {Adam Ryszard Kowalówka and Julia Wojtczak and Maria Zwinczak and Barbara Wawrzyńczak and Mikołaj Jodłowski and Radosław Gocoł},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207803},
url = {https://www.mdpi.com/2077-0383/15/20/7803},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Minimally Invasive Aortic Valve Replacement and Perioperative Stroke Risk: A Propensity-Matched Analysis
AU - Adam Ryszard Kowalówka
AU - Julia Wojtczak
AU - Maria Zwinczak
AU - Barbara Wawrzyńczak
AU - Mikołaj Jodłowski
AU - Radosław Gocoł
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207803
UR - https://www.mdpi.com/2077-0383/15/20/7803
AB - Background/Objectives: Stroke is a devastating complication after aortic valve replacement (AVR). Whether minimally invasive AVR (miniAVR) reduces perioperative stroke risk versus conventional sternotomy remains uncertain. Methods: This single-center retrospective cohort study used propensity score matching (PSM) in 1741 consecutive patients undergoing isolated AVR (2014–2025). After exclusions, 1:1 PSM using 10 covariates created 155 matched pairs with excellent balance (all standardized mean differences < 0.20). The primary endpoint was in-hospital stroke or transient ischemic attack (TIA); secondary endpoints were 30-day and 5-year mortality and major complications. Firth penalized logistic regression identified independent predictors of stroke/TIA. Results: Stroke/TIA occurred in 0/155 (0.0%) miniAVR versus 7/155 (4.5%) conventional patients (p = 0.015); the rule-of-three upper 95% limit for miniAVR was ~1.9%. Thirty-day mortality was similar (0.6% vs. 2.6%; p = 0.371). Five-year survival favored miniAVR (94.6% vs. 87.2%; log-rank p = 0.047). miniAVR was independently associated with lower stroke/TIA odds (odds ratio [OR] 0.052; 95% confidence interval [CI] 0.003–0.832; p = 0.037); longer cardiopulmonary bypass time was associated with higher odds (OR 1.014/minute; 95% CI 1.001–1.028; p = 0.032). Conclusions: miniAVR was associated with zero observed perioperative strokes and higher 5-year survival; however, this survival comparison is limited by short median follow-up in the miniAVR group (1.9 years). Given the small number of events and the single-center design, these findings should not be interpreted as proof of a causal neuroprotective effect. Multicenter validation with longer, balanced follow-up is required.
SN - 2077-0383
ER -