Key result
Aortic valve predilatation during TAVR is linked to ~128% higher 30-day stroke risk.
Why the study?
Existing data on 30-day stroke after TAVR came from early studies with first-generation devices, and the incidence and predictors of 6-month stroke remained unknown.
Cohort (n=2,753)
Yes
Stroke after TAVR is rare (1.3% at 30 days, 2.4% at 6 months), with aortic valve predilatation being the only procedural predictor for 30-day stroke, highlighting the importance of preoperative risk stratification.
Predilatation warrants caution in TAVR; leaves open whether technique modification reduces stroke in randomized trials.
BACKGROUND: The incidence and predictors of 30-day stroke after transcatheter aortic valve replacement (TAVR) were derived from early studies investigating first-generation devices. The incidence of 6-month stroke and its related predictors are unknown. AIMS: To investigate the incidence and to identify procedural and patient-related predictors of 30-day and 6-month stroke after TAVR. METHODS: Data from 2753 consecutive patients with severe aortic stenosis undergoing TAVR were obtained from the OBSERVANT-II study, an observational, prospective, multicenter cohort study. The study endpoints were symptomatic 30-day and 6-month stroke after TAVR. RESULTS: The occurrence of a 30-day and 6-month stroke was low (1.3% and 2.4%, respectively) but with significant impact on survival. Aortic valve predilatation (odds ratio [OR]: 2.28, 95% confidence interval [CI]: 1.12-4.65, p = 0.023), diabetes (OR: 3.10, 95% CI: 1.56-6.18, p = 0.001), and left ventricle ejection fraction < 50% (OR: 2.15, 95% CI: 1.04-4.47, p = 0.04) were independent predictors of 30-day stroke, whereas diabetes (sub-distribution hazard ratio [SHR]: 2.07, 95% CI: 1.25-3.42, p = 0.004), pre-existing neurological dysfunction (SHR: 3.92, 95% CI: 1.54-10, p = 0.004), bicuspid valve (SHR: 4.75, 95% CI: 1.44-15.7, p = 0.011), and critical status (SHR: 3.05, 95% CI: 1.21-7.72, p = 0.018) were predictive of 6-month stroke. Conversely, antiplatelet therapy and anticoagulation were protective factors at both 30 days and 6 months. CONCLUSIONS: Stroke after TAVR was rare. Predilatation was the only procedural factor predictive of 30-day stroke, whereas the remaining were patient-related risk factors, suggesting appropriate risk stratification preoperatively.
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Gorla et al. (2023) conducted a cohort in Severe aortic stenosis (n=2,753). Aortic valve predilatation vs. No predilatation was evaluated on Symptomatic 30-day stroke (OR 2.28, 95% CI 1.12-4.65, p=0.023). Aortic valve predilatation independently predicted 30-day stroke after TAVR (OR 2.28; 95% CI 1.12-4.65; p=0.023), though overall stroke incidence was low at 30 days (1.3%) and 6 months (2.4%).
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