May 4, 2026

Thromboembolic Complications After Surgical Correction of Mitral Regurgitation

Structured PICO

Does surgical correction of mitral regurgitation affect the risk of ischemic stroke in patients with mitral regurgitation compared to the general population?

Population

1,344 patients consecutively operated for mitral regurgitation (MR), mean age 65 +/- 12 years.

Intervention

Surgical correction of mitral regurgitation (mitral valve repair [n=897], mechanical mitral valve replacement [n=231], or biological mitral valve replacement [n=216])

Comparator

General population (for expected ischemic stroke rates) and comparison between surgical procedures (repair vs. biological replacement vs. mechanical replacement)

Outcome

Thromboembolic complications, particularly ischemic stroke (IS) assessed early (<30 days), midterm (30 to 180 days), and long-term (>=180 days)hard clinical

While early ischemic stroke risk is high after mitral regurgitation surgery, long-term risk is similar to the general population for patients undergoing valve repair or biological replacement, supporting a preference for valve repair.

Abstract

OBJECTIVES: We sought to define thromboembolic risk after surgery for mitral regurgitation (MR), particularly ischemic stroke (IS) compared with the general population. BACKGROUND: Guidelines recommend surgery in asymptomatic patients with MR, but IS risks are unknown. METHODS: In 1,344 patients (age 65 +/- 12 years) consecutively operated for MR (procedures: 897 mitral valve repair MRep and 447 valve replacement: 231 mechanical mitral valve replacement MVRm, 216 biological mitral valve replacement MVRb), thromboembolic complications, particularly IS (diagnosed by neurologists), during follow-up were assessed early (or=180 days). RESULTS: Ischemic stroke occurred in 130 patients: 1.9 +/- 0.4% and 2.7 +/- 0.5% at 30 days and 180 days, respectively, and 8.1 +/- 0.8% at 5 years. We found that IS rates were lowest after MRep versus MVRb and MVRm (6.1 +/- 0.9% vs. 8 +/- 2.1%, and 16.1 +/- 2.7% at 5 years, respectively, p 0.10 between procedures) and moderate risk at >30 days (risk ratio 1.7 overall; 1.3 for MRep; 0.98 for MVRb; 4.8 for MVRm). Beyond 180 days, IS risk declined further and was similar to the population for MRep (relative risk 1.2) and for MVRb (relative risk 0.9). Bleeding risk >30 days was lowest in MRep versus MVRb and MVRm (10-year risk 7 +/- 1%, 14 +/- 4%, and 16 +/- 3%, respectively). CONCLUSIONS: Thromboembolic complications after MR surgery are a reason for both concern and encouragement. The risk of IS is notable early, irrespective of procedure, but in the long term it is not greater than in the population after MRep and MVRb. Preference for MRep should be emphasized, and trials aiming at preventing IS should be conducted to reduce thromboembolic and hemorrhagic risk after surgery for MR.

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