TAVR was associated with significantly lower odds of stroke at 30 days compared to surgical AVR (OR 0.73), but no significant difference was observed at 1, 2, or 5 years.
Does TAVR reduce the risk of stroke compared to surgical AVR in adults with severe aortic stenosis?
TAVR is associated with a lower 30-day risk of stroke compared to surgical AVR, but long-term stroke risk is similar between the two procedures.
Absolute Event Rate: 0% vs 0%
BACKGROUND: Stroke is a possible complication after bioprosthetic aortic valve replacement (AVR) for severe aortic stenosis (AS), impacting morbidity and mortality. Accurate estimates of the proportion of individuals who experience stroke within and beyond the periprocedural period after transcatheter AVR (TAVR), surgical AVR, and valve-in-valve (ViV) replacement are essential for management and prognostication. The objective was to determine the proportion of adults aged >18 who experienced an ischemic stroke after bioprosthetic AVR for AS. METHODS: A systematic search of MEDLINE, Embase, and Web of Science was conducted from database inception through March 2024. Studies reporting on stroke rates at least 90 days after bioprosthetic AVR for severe AS, including ViV procedures, and meeting predefined eligibility criteria were included. The pooled proportion of individuals experiencing a stroke was estimated for TAVR and ViV procedures, whereas comparative analyses between TAVR and surgical AVR were performed using mixed-effects models in studies directly comparing both procedures. RESULTS: Twenty-seven studies were included in the native AS treatment cohort, and 5 in the ViV subanalysis. In native AS, the pooled 30-day proportion of individuals who had a stroke after TAVR was 3.0% (95% CI, 2.5–3.9), with different studies reporting major and minor stroke proportions of 1.7% each. At 1 year, all stroke proportion was 5.0% (95% CI, 4.0–6.0), major stroke was 3.0%, and minor stroke was 2.0%. Comparative analysis demonstrated that TAVR was associated with significantly lower odds of all stroke at 30 days compared with surgical AVR (odds ratio, 0.73 95% CI, 0.57–0.93). No significant difference in the proportions of individuals who had a stroke was observed in TAVR versus surgical AVR at 1, 2, or 5 years. In the ViV cohort, the pooled 30-day and 1-year all stroke proportion after ViV was 2.0% (95% CI, 1.0–3.0) and 3.0% (95% CI, 2.0–6.0), respectively. CONCLUSIONS: This meta-analysis provides updated estimates of stroke after bioprosthetic AVR for AS, capturing risk beyond the early periprocedural period. Future studies should investigate the causes of long-term stroke post-AVR, the effects of different antithrombotic therapies on the risk of stroke, as well as the potential impact of these procedures on short and long-term cognitive function.
Dargham et al. (Fri,) reported a other. TAVR was associated with significantly lower odds of stroke at 30 days compared to surgical AVR (OR 0.73), but no significant difference was observed at 1, 2, or 5 years.