Stroke after transcatheter aortic valve replacement: A severe complication with low predictability

• Published in: Catheterization and cardiovascular interventions 2022-05, Vol.99 (6), p.1897-1905
• Main Authors: Eschenbach, Lena K., Erlebach, Magdalena, Deutsch, Marcus‐André, Ruge, Hendrik, Bleiziffer, Sabine, Holzer, Lisa, Krane, Markus, Voss, Stephanie, Lange, Ruediger, Burri, Melchior
• Format: Article
• Language: English
• Subjects: Aortic valve; cerebrovascular events; Ischemia; Lesions; neurological events; Risk factors; Stroke; Transient ischemic attack
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.30143

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.