Abstract 12446: Predictors of Early Cerebrovascular Events Following Transcatheter Aortic Valve Implantation. Insights From a Large Cohort Of Patients
Background: Transcatheter aortic valve implantation (TAVI) represents an alternative to surgical aortic valve replacement in high risk patients, but recent studies have raised major concern because of increase cerebrovascular event (CVE) rates. The aim of the study was to evaluate the timing and predictive factors of CVE following TAVI.
Methods: TAVI with balloon- (64%) or self- (36%) expandable valve was performed in 1061 consecutive patients in five centers. CVE were classified as acute (≤24 hours) or subacute (1 to 30 days) according to the timing and categorized as transient ischemic attack (TIA) or stroke (major or minor), according to the VARC criteria. All clinical, echocardiographic, procedural, and follow-up data were prospectively recorded.
Results: CVE occurred in 54 patients (5.1%), which 29 (54%) were acute and 25 (46%) subacute. The 30-day rate of TIA, minor and major stroke was 0.8%, 1.4% and 2.8%, respectively. Hemorrhagic stroke was recorded in 2 patients. Balloon postdilation (OR: 2.46, 95% CI: 1.07-5.67) and valve dislodgment/embolization (OR: 4.36, 95% CI: 1.21-15.69) were independent predictors for acute CVE while new onset atrial fribrillation [NOAF] (OR 2.72, 95% CI 1.10-6.73) was the only predictor of subacute CVE.
Conclusions: CVE within 30 days following TAVI occurred in 5.1% in this large cohort of patients, half of them in the first 24 hours. A higher incidence of acute CVE was observed in patients with balloon postdilation or valve dislodgment/embolization, while atrial arrhythmias (NOAF) were associated with sub-acute CVE. These findings may have implications for the application of preventive and therapeutic measures in patients undergoing TAVI.
- © 2012 by American Heart Association, Inc.