{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:00:52Z","timestamp":1753876852307,"version":"3.41.2"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T00:00:00Z","timestamp":1731974400000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003793","name":"Swedish Heart-Lung Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Analysis of the long-term risks of ischaemic stroke and cerebral bleeding in patients with atrial fibrillation after mitral valve surgery and concomitant Cox-maze IV procedure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>In total, 397 patients with symptomatic degenerative mitral valve insuffciency and atrial fibrillation, underwent mitral valve surgery and Cox-maze IV in Sweden between 2009 and 2017. In this retrospective nationwide analysis, patients were followed in national patient registers until 30 September 2022.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>There were 4 deaths within 30\u2009days (1.0%). Mean follow-up was 8.7 (0.1\u201313.4) years. Survival without ischaemic stroke or cerebral haemorrhage at 5 and 10 years were 90% and 74%, respectively. Nineteen patients experienced an ischaemic stroke, of which 4 were fatal. Five of 34 patients (14.7%) with a history of stroke preoperatively experienced ischaemic stroke during follow-up. The linearized rate of ischaemic stroke per patient-year was 0.6% and was similar regardless of left atrial appendage closure during surgery or whether a mechanical valve was inserted. The observed ischaemic stroke rate was lower than the predicted rate for all CHA2DS2-VASc score groups. Fourteen patients suffered cerebral bleeding, of which 3 were fatal. Patients who experienced cerebral bleeding were older and had higher mechanical valve implantation rate than those without cerebral bleeding.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Surgery for mitral valve insufficiency and concomitant Cox-maze IV can be performed with low perioperative risk. There is a low continuing risk of stroke long-term postoperatively that correlates with a higher CHA2DS2-VASc score. Patients with preoperative stroke are at increased risk of postoperative stroke despite atrial fibrillation surgery.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/icvts\/ivae189","type":"journal-article","created":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T06:53:53Z","timestamp":1731999233000},"source":"Crossref","is-referenced-by-count":0,"title":["Risk of neurologic events after surgery for mitral valve insufficiency and concomitant Cox-maze IV procedure for atrial fibrillation. A nationwide register-based study"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1267-0912","authenticated-orcid":false,"given":"Anders","family":"Alb\u00e5ge","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery and Anesthesiology, University Hospital , Uppsala,","place":["Sweden"]},{"name":"Department of Surgical Sciences, Uppsala University , Uppsala,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1005-091X","authenticated-orcid":false,"given":"Farkas","family":"Vanky","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Vascular Surgery, Link\u00f6ping University , Link\u00f6ping,","place":["Sweden"]},{"name":"Unit of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Link\u00f6ping University , Link\u00f6ping,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9122-0890","authenticated-orcid":false,"given":"Gabriella","family":"Boano","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Vascular Surgery, Link\u00f6ping University , Link\u00f6ping,","place":["Sweden"]},{"name":"Unit of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Link\u00f6ping University , Link\u00f6ping,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1185-0452","authenticated-orcid":false,"given":"Anders","family":"Holmgren","sequence":"additional","affiliation":[{"name":"Heart Centre and Department of Public Health and Clinical Medicine, Ume\u00e5 University , 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University Hospital, Karolinska Institutet , Stockholm,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5786-864X","authenticated-orcid":false,"given":"Shahab","family":"Nozohoor","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Sk\u00e5ne University Hospital, Lund University , Lund,","place":["Sweden"]},{"name":"Department of Cardiothoracic Surgery, Sk\u00e5ne University Hospital, Lund University , Lund,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henrik","family":"Scherst\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic Surgery, Sahlgrenska University Hospital , 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