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Hypothermic fibrillatory arrest may not increase stroke risk in minimally invasive mitral valve surgery: A 13-year propensity score–matched experience

Year: 2026

Type: article

Abstract: Objectives Hypothermic fibrillatory arrest (HFA) has been associated with increased stroke risk in minimally invasive mitral valve surgery though selection bias may confound this association. Methods Single-center retrospective analysis of minimally invasive mitral valve surgeries (July/2011-December/2024) stratified by myocardial protection strategy (hypothermic fibrillatory arrest versus aortic cross-clamping), assessed using propensity score matching and multivariable logistic regression. Results Of 1,258 patients, 984 underwent fibrillatory arrest and 274 received aortic cross-clamping. The fibrillatory arrest group had more complex profiles, higher rates of prior myocardial infarction (14.2% vs. 4.7%), previous cardiac surgery (12.8% vs. 2.2%), urgent/emergent status (18.8% vs. 10.2% all p < .05). Despite these higher-risk profiles, post-operative stroke rates were comparable (3.1% vs. 3.7%, p=0.57). After propensity matching, stroke remained comparable (3.3% vs. 3.7%), and fibrillatory arrest was not independently associated with increased stroke risk (OR: 0.94; p=0.91). In-hospital mortality was also comparable (HFA: 2.6% vs ACC: 1.5%). Conclusions HFA demonstrates non-inferior stroke outcomes compared to ACC when performed with meticulous protocols at high-volume centers. These findings do not support HFA as a replacement for ACC, but rather as a viable alternative when clinically and technically indicated.

Source: JTCVS Open

DOI: 10.1016/j.xjon.2026.102054