Minimally Invasive Aortic Valve Replacement and Perioperative Stroke Risk: A Propensity-Matched Analysis

Background/Objectives: Stroke is a devastating complication after aortic valve replacement (AVR). Whether minimally invasive AVR (miniAVR) reduces perioperative stroke risk versus conventional sternotomy remains uncertain.

Methods

This single-center retrospective cohort study used propensity score matching (PSM) in 1741 consecutive patients undergoing isolated AVR (2014–2025). After exclusions, 1:1 PSM using 10 covariates created 155 matched pairs with excellent balance (all standardized mean differences < 0.20). The primary endpoint was in-hospital stroke or transient ischemic attack (TIA); secondary endpoints were 30-day and 5-year mortality and major complications. Firth penalized logistic regression identified independent predictors of stroke/TIA.

Results