Key result
In patients undergoing TAVI, baseline mitral regurgitation grade, HbA1c, and prior cerebrovascular events were independently associated with in-hospital stroke, whereas post-dilatation and very severe aortic stenosis predicted mid-to-long term stroke.
Why the study?
Whether early and post-discharge cerebrovascular events after TAVI are associated with distinct clinical, echocardiographic, haemodynamic, and procedural predictors remains incompletely clarified.
Cohort (n=556)
Yes
Answers are grounded in this paper and cite their sources.
Early and post-discharge cerebrovascular events after TAVI are infrequent but have distinct predictor profiles, with early strokes linked to patient comorbidities (mitral regurgitation, HbA1c, prior stroke) and later strokes linked to procedural and anatomical factors (post-dilatation, very severe aortic stenosis).
Background and Objectives: Cerebrovascular events remain among the most feared complications after transcatheter aortic valve implantation (TAVI). Whether early and post-discharge cerebrovascular events are associated with distinct clinical, echocardiographic, haemodynamic, and procedural predictors remains incompletely clarified. Materials and Methods: This retrospective, observational, two-center cohort study included 556 patients who underwent TAVI for severe symptomatic aortic stenosis between October 2011 and May 2023. The primary outcomes were in-hospital stroke and mid-to-long term stroke occurring after hospital discharge. Stroke diagnoses were established by neurological assessment and confirmed by cranial computed tomography and/or magnetic resonance imaging. Univariable comparisons and Firth penalized multivariable logistic regression analyses were performed to identify predictors of each outcome. Results: In-hospital stroke occurred in 14 patients (2.5%), whereas mid-to-long term stroke occurred in 16 patients (2.9%). In Firth penalized multivariable analysis, baseline mitral regurgitation grade (odds ratio [OR] 2.174, 95% confidence interval [CI] 1.299–3.638; p = 0.003), HbA1c (OR 1.644, 95% CI 1.111–2.433; p = 0.013), and prior cerebrovascular event (OR 4.269, 95% CI 1.150–15.846; p = 0.030) were independently associated with in-hospital stroke. For mid-to-long term stroke, post-dilatation (OR 9.862, 95% CI 2.555–38.067; p < 0.001) and very severe aortic stenosis phenotype (OR 3.649, 95% CI 1.343–9.916; p = 0.011) were independently associated with the outcome. Conclusions: Early and post-discharge cerebrovascular events after TAVI were infrequent but associated with distinct predictor profiles. In-hospital stroke was associated with baseline mitral regurgitation grade, HbA1c, and prior cerebrovascular event, whereas mid-to-long term stroke was associated with post-dilatation and very severe aortic stenosis phenotype. Given the limited number of events, these findings should be interpreted as exploratory and require validation in larger prospective cohorts.
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Ertop et al. (2026) conducted a cohort in Severe symptomatic aortic stenosis (n=556). Baseline mitral regurgitation grade vs. Lower baseline mitral regurgitation grade was evaluated on In-hospital stroke (OR 2.174, 95% CI 1.299-3.638, p=0.003). In patients undergoing TAVI, baseline mitral regurgitation grade, HbA1c, and prior cerebrovascular events were independently associated with in-hospital stroke, whereas post-dilatation and very severe aortic stenosis predicted mid-to-long term stroke.
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