OBJECTIVE: We evaluated risk factors for mortality and @entity64 after mechanical mitral valve replacement between May 1977 and December 2001. METHODS: Early and late mortality and @entity64 were assessed. Potential predictors of mortality and @entity64 were entered into a Cox proportional hazards model. Actuarial survival and freedom from @entity64 were determined by a log-rank test. RESULTS: Mitral valve replacement was performed in 812 @entity1 . Concomitant procedures included left atrial appendage closure in 493 (61%) @entity1 , tricuspid annuloplasty-replacement in 348 (43%) @entity1 , maze procedure in 185 (23%) @entity1 , plication of the left atrium in 148 (18%) @entity1 , and other procedures in 151 (19%) @entity1 . Five-year actuarial survival was 91.1% +/- 2.3%. Freedom from @entity64 at 8 years was significantly better in @entity1 with sinus rhythm versus @entity955 (P <.001). Ninety-nine percent of @entity1 with mitral valve replacement combined with a maze procedure were free from @entity64 , whereas only 89% of @entity1 with mitral valve replacement alone were free from @entity64 at 8 years after surgical intervention. Seventy-two @entity1 had late @entity64 ; sixty-five @entity1 (90%) were in @entity955 , and 47 (65%) @entity1 had the left atrial appendage closed. Multivariate analysis showed that late @entity955 (odds ratio, 3.39; 95% confidence interval, 1.72-6.67; P =.0001) and omission of the maze procedure (odds ratio, 3.40; 95% confidence interval, 1.14-10.14; P =.003) were the significant risk factors for late @entity64 . CONCLUSIONS: Persistent @entity955 was the most significant risk factor for late @entity64 after mechanical mitral valve replacement. Restoration of sinus rhythm with a maze procedure nearly eliminated the risk of late @entity64 , whereas neither closure of the left atrial appendage nor therapeutic anticoagulation prevented this complication.

Early and late XXXX after mitral valve replacement with a mechanical prosthesis: risk factor analysis of a 24-year experience.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity64 :: ('MESH:D020521', 'Disease') :: ['stroke'] @entity955 :: ('MESH:D001281', 'Disease') :: ['atrial fibrillation']
@entity64 :: (MESH:D020521,Disease) :: ['stroke']
