Postdeployment balloon dilation during transcatheter aortic valve replacement was independently associated with an increased risk of 30-day stroke or transient ischemic attack (HR 4.95).
Cohort (n=370)
No
Does postdeployment balloon dilation or emergent cardiopulmonary bypass increase the risk of stroke or TIA in patients undergoing transcatheter aortic valve replacement?
Postdeployment balloon dilation and emergent cardiopulmonary bypass during TAVR are independently associated with a significantly increased risk of stroke or TIA at 30 days, suggesting that appropriate valve sizing to minimize postdilation may improve neurological outcomes.
Hazard Ratio: 4.95 (95% CI 1.02–24.03)
Absolute Event Rate: 9.4% vs 2.2%
p-value: p=0.04
Objectives: The objective was to assess the impact of procedural characteristics on risk of stroke or transient ischaemic attack (TIA) after transcatheter aortic valve replacement (TAVR). Methods: We included 370 consecutive patients who underwent balloon-expandable TAVR from 1 November 2008 to 30 June 2014. Procedural characteristics that may be associated with stroke/TIA were assessed. The primary outcome was stroke/TIA at 30 days. A propensity score was constructed using a logistic regression model with 29 parameters. Cox proportional hazards models were used with a propensity score covariate. Results: Mean age was 80.9±7.9 years and mean Society of Thoracic Surgeons score was 8.3±5.0. The total number of balloon dilations ranged from 2 to 7. Out of 370 patients, 13 patients (3.5%) suffered stroke/TIA in the first 30 days after TAVR. In univariate analysis, postdeployment balloon dilation (PD) (HR 3.8, 95% CI 1.24 to 11.61; p=0.02) and emergent cardiopulmonary bypass (CPB) (HR 9.66, 95% CI 2.66 to 35.15; p<0.001) were significantly associated with 30-day stroke/TIA. In the multivariable Cox-proportional hazards model, PD (HR 4.95, 95% CI 1.02 to 24.03; p=0.04) and emergent CPB (HR 7.15, 95% CI 1.39 to 36.89; p=0.02) were independently associated with increased risk of 30-day stroke/TIA after adjusting for propensity score, total number of balloon dilations and periprosthetic regurgitation. Conclusion: Postdilation as compared with total number of dilations, and emergent CPB were independently associated with increased risk of clinical neurological events in the first 30 days after TAVR. Reduction in balloon postdilation with appropriate valve sizing may reduce the risk of stroke or TIA after TAVR.
Goel et al. (Mon,) conducted a cohort in Severe aortic stenosis (n=370). Postdeployment balloon dilation vs. No postdeployment balloon dilation was evaluated on Stroke or transient ischaemic attack (TIA) at 30 days (HR 4.95, 95% CI 1.02 to 24.03, p=0.04). Postdeployment balloon dilation during transcatheter aortic valve replacement was independently associated with an increased risk of 30-day stroke or transient ischemic attack (HR 4.95).