Incidence, Timing, and Determinants of Stroke After Mitral Repair in Patients Without Preoperative Atrial Fibrillation
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.
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BibTeX
@article{kutsuzawa2026incidence,
title = {{Incidence, Timing, and Determinants of Stroke After Mitral Repair in Patients Without Preoperative Atrial Fibrillation}},
author = {Rieko Kutsuzawa and Satoshi Kainuma and Naonori Kawamoto and Kizuku Yamashita and Kota Suzuki and Takashi Kakuta and Ayumi Ikuta and Shinichi Kurashima and Yuki Irie and Kenji Moriuchi and Masashi Amano and Atsushi Okada and Makoto Amaki and Hideaki Kanzaki and Takeshi Kitai and Chisato Izumi and Kazuhiro Yamamoto and Takashi Daimon and Satsuki Fukushima},
journal = {Circulation Journal},
year = {2026},
month = aug,
doi = {10.1253/circj.cj-26-0035},
url = {https://www.jstage.jst.go.jp/article/circj/90/9/90_CJ-26-0035/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Incidence, Timing, and Determinants of Stroke After Mitral Repair in Patients Without Preoperative Atrial Fibrillation
AU - Rieko Kutsuzawa
AU - Satoshi Kainuma
AU - Naonori Kawamoto
AU - Kizuku Yamashita
AU - Kota Suzuki
AU - Takashi Kakuta
AU - Ayumi Ikuta
AU - Shinichi Kurashima
AU - Yuki Irie
AU - Kenji Moriuchi
AU - Masashi Amano
AU - Atsushi Okada
AU - Makoto Amaki
AU - Hideaki Kanzaki
AU - Takeshi Kitai
AU - Chisato Izumi
AU - Kazuhiro Yamamoto
AU - Takashi Daimon
AU - Satsuki Fukushima
PY - 2026
DA - 2026/08/25
JO - Circulation Journal
DO - 10.1253/circj.cj-26-0035
UR - https://www.jstage.jst.go.jp/article/circj/90/9/90_CJ-26-0035/_article
AB - 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.
SN - 1347-4820
SN - 1346-9843
ER -