Key result
Post-TAVR stroke is linked to ~169% higher 30-day mortality.
Why the study?
Stroke and transient ischemic attacks after transcatheter aortic valve replacement are major complications with limited data on associated risk factors.
Cohort (n=1,919)
No
Absolute Event Rate: 13.2% vs 4.9%
p-value: p=0.005
Stroke after TAVR occurs in approximately 3.9% of patients, is predicted by prior stroke and early center experience, and significantly increases 30-day mortality.
Stroke after TAVR markedly raises 30-day mortality; retrospective data leave open whether targeting prior stroke or operator experience reduces events.
OBJECTIVES: We aimed to describe stroke and transient ischemic attacks (TIAs) after transcatheter aortic valve replacement (TAVR) and to identify associated risk factors. BACKGROUND: Stroke/TIA after TAVR is a major complication. METHODS: A total of 1919 concomitant patients underwent TAVR in a single center from 2007 to 2017. Pre-, intra-, and postprocedural data were collected prospectively in a database and analyzed retrospectively. Stroke and TIA were documented according to the Valve Academic Research Consortium-II criteria. Logistic regression was used to determine risk factors for stroke after TAVR. RESULTS: Mean age was 79.5 ± 6.8 years, mean logistic EuroScore was 17.6% ± 12.8%, and 51.8% (n = 994) of the patients were female. Stroke/TIA occurred in 76 patients (3.9%), 1.9% were disabling, and 1.6% nondisabling. The predominant type of stroke were territorial ischemic lesions (82.4%), with primary bleeding in 4.4% and border zone infarctions in 4.4%. Left-sided lesions were more common (45.6% left sided vs. 25% right sided) and 13.2% of the lesions were bilateral (4.4% no finding and 11.8% missing data). In multivariate logistic regression, prior stroke (odds ratio [OR] = 1.83, p = 0.046) and initial experience (first 300 TAVR implanted at our center) were identified as independent risk factors for stroke/TIA during the first 30 days (OR = 1.95, p = 0.045). Overall, the occurrence of stroke had a highly significant impact on a 30-day mortality (13.2% vs. 4.9% in patients without stroke (p = 0.005). CONCLUSION: Stroke within the first 30 days after TAVR severely impairs 30-day survival. We identified prior stroke and initial experience as significant independent risk factors for the occurrence of stroke after TAVR.
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Eschenbach et al. (2022) conducted a cohort in Transcatheter aortic valve replacement (n=1,919). Stroke after TAVR vs. No stroke after TAVR was evaluated on 30-day mortality (p=0.005). Prior stroke and initial center experience were risk factors for stroke after TAVR, which significantly increased 30-day mortality compared to patients without stroke (13.2% vs 4.9%, p=0.005).
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