May 1, 2012Open Access
View Full PaperCerebrovascular accidents complicating transcatheter aortic valve implantation: frequency, timing and impact on outcomes
Structured PICO
Does periprocedural CVA impact 30-day mortality in high-risk elderly patients undergoing TAVI?
P
Population
n=389 high-risk elderly patients with symptomatic severe aortic stenosis undergoing TAVI via transfemoral, transapical or subclavian access
I
Intervention
Transcatheter aortic valve implantation (TAVI) complicated by cerebrovascular accident (CVA)
C
Comparator
Transcatheter aortic valve implantation (TAVI) without cerebrovascular accident (CVA)
O
Outcome
Frequency and timing of CVA, and all-cause and cardiovascular mortality at 30 dayshard clinical
Periprocedural CVA after TAVI is a rare but devastating complication that predominantly occurs within the first 24 hours and is associated with a nearly 12-fold increased risk of 30-day mortality.
Abstract
AIMS: Cerebrovascular accidents (CVA) are considered among the most serious adverse events after transcatheter aortic valve implantation (TAVI). The objective of the present study was to evaluate the frequency and timing of CVA after TAVI and to investigate the impact on clinical outcomes within 30 days of the procedure. METHODS AND RESULTS: Between August 2007 and October 2011, 389 high-risk elderly patients with symptomatic severe aortic stenosis underwent TAVI via transfemoral, transapical or subclavian access. A total of 14 patients (3.6%) experienced at least one CVA within 30 days of follow-up and most events (74%) occurred within the first day of the procedure. Patients with CVA had an increased risk of all-cause (42.3% vs. 5.1%, ORadjusted 11.7, 95% CI 3.4-40.3, p<0.001) and cardiovascular mortality (38.4% vs. 4.6%, ORadjusted 10.5, 95% CI 2.9-37.8, p<0.001) compared to patients without CVA at 30 days of follow-up. Repeated device implantation attempts (ORadjusted 8.3, CI 2.1-33.3, p<0.003), chronic pulmonary disease (ORadjusted 4.7, CI 1.3-16.8, p=0.02) and body mass index <25 kg/m2 (ORadjusted 0.8, CI 0.7-0.9, p<0.01) emerged as independent predictors of periprocedural CVA. CONCLUSIONS: Cerebrovascular accidents among patients undergoing TAVI occur predominantly during the periprocedural period, are associated with multiple implantation attempts of the bioprosthesis and significantly impair prognosis.