Key result
TAVR links to fewer strokes over time, but nonfemoral access increases delirium and cognitive decline.
Why the study?
Reported rates of neurological complications after TAVR have varied over time and diagnostic definitions, with conflicting results comparing stroke rates between TAVR and SAVR.
This narrative review summarizes the incidence and risks of neurological complications after TAVR, noting decreased stroke rates over time but increased delirium and cognitive decline with nonfemoral access.
Supports declining stroke rates with contemporary TAVR; leaves open whether nonfemoral access cognitive risks warrant practice changes.
Transcatheter aortic valve replacement (TAVR) has become the dominant procedural modality for aortic valve replacement in the United States. The reported rates of neurological complications in patients undergoing TAVR have changed over time and are dependent on diagnostic definitions and modalities. Most strokes after TAVR are likely embolic in origin, and the incidence of stroke has decreased over time. Studies have yielded conflicting results when comparing stroke rates between TAVR and surgical aortic valve replacement (SAVR), especially due to differences in diagnostic criteria and neurocognitive testing. In this narrative review, we summarize the available data on the incidence of stroke, delirium, and cognitive decline after TAVR and highlight potential areas in need of future research. We also discuss silent cerebral ischemic lesions (SCILs) and their association with a decline in postoperative neurocognitive status after TAVR. Finally, we describe that the risk of delirium and postoperative decline is increased when nonfemoral access routes are used, and we highlight the need for standardized imaging and valid, repeatable methodologies to assess cognitive changes after TAVR.
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Mangold et al. (2024) conducted a review in Aortic valve disease requiring replacement. Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Neurological complications including stroke, delirium, and cognitive decline. Transcatheter aortic valve replacement is associated with decreasing stroke incidence over time, while nonfemoral access routes increase the risk of delirium and postoperative cognitive decline.
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