Stroke After Surgical Versus Transfemoral Transcatheter Aortic Valve Replacement in the PARTNER Trial

• Published in: Journal of the American College of Cardiology 2018-11, Vol.72 (20), p.2415-2426
• Main Authors: Kapadia, Samir R., Huded, Chetan P., Kodali, Susheel K., Svensson, Lars G., Tuzcu, E. Murat, Baron, Suzanne J., Cohen, David J., Miller, D. Craig, Thourani, Vinod H., Herrmann, Howard C., Mack, Michael J., Szerlip, Molly, Makkar, Raj R., Webb, John G., Smith, Craig R., Rajeswaran, Jeevanantham, Blackstone, Eugene H., Leon, Martin B.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic stenosis; Aortic valve; Aortic Valve Stenosis - epidemiology; Aortic Valve Stenosis - surgery; Bioprosthesis - adverse effects; Bioprosthesis - trends; Cardiology; Cardiomyopathy; Cardiovascular disease; cerebrovascular accident; Clinical trials; Cohort Studies; Comorbidity; Coronary vessels; Female; Health risks; Heart Valve Prosthesis - adverse effects; Heart Valve Prosthesis - trends; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - trends; Humans; Male; Mortality; Patients; Placement; Postoperative Complications - diagnostic imaging; Postoperative Complications - epidemiology; Quality of life; Risk Factors; Software; Stenosis; Stroke; Stroke - diagnostic imaging; Stroke - epidemiology; Surgery; TAVR; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - trends; Treatment Outcome
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2018.08.2172

Transfemoral-transcatheter aortic valve replacement (TF-TAVR) is increasingly used to treat aortic stenosis, but risk of post-procedure stroke is uncertain. The purpose of this study was to assess stroke risk and its association with quality of life after surgical aortic valve replacement (SAVR) versus TF-TAVR. The authors performed a propensity-matched study of 1,204 pairs of patients with severe aortic stenosis treated with SAVR versus TF-TAVR in the PARTNER (Placement of AoRTic TraNscathetER Valves) trials from April 2007 to October 2014. Outcomes were: 1) 30-day neurological events; 2) time-varying risk of neurological events early (≤7 days) and late (7 days to 48 months) post-procedure; and 3) association between stroke and quality of life 1 year post-procedure by the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score. Thirty-day stroke (5.1% vs. 3.7%; p = 0.09) was similar, but 30-day major stroke (3.9% vs. 2.2%; p = 0.018) was lower after TF-TAVR than SAVR. In both groups, risk of stroke peaked in the first post-procedure day, followed by a near-constant low-level risk to 48 months. Major stroke was associated with a decline in quality of life at 1 year in both SAVR (KCCQ score median [15th, 85th percentile]: 79 [53, 94] without major stroke vs. 64 [30, 94] with major stroke; p = 0.03) and TF-TAVR (78 [49, 96] without major stroke vs. 60 [8, 99] with major stroke; p = 0.04). Despite similar early-peaking (