Timing, Predictive Factors and Prognostic Value of Cerebrovascular Events in a Large Cohort of Patients Undergoing Transcatheter Aortic Valve Implantation
Background—The objective of this study was to evaluate the timing, predictive factors and prognostic value of cerebrovascular events (CVEs) following transcatheter aortic valve implantation (TAVI).
Methods and Results—The study included 1061 consecutive patients who underwent TAVI with a balloon- (64%) or a self- (36%) expandable valve. CVEs were classified as acute (≤24 hours), subacute (1-30 days), and late (>30 days). CVEs occurred in 54 patients (5.1%; stroke:4.2%) within 30 days following TAVI (acute in 54% of cases). The predictors of acute CVEs were balloon postdilation of the valve prosthesis (OR:2.46, 95% CI:1.07-5.67) and valve dislodgment/embolization (OR:4.36, 95%CI:1.21-15.69); new-onset atrial fibrillation [NOAF] (OR:2.76, 95%CI:1.11-6.83) was the predictor of subactute CVEs. Late CVEs occurred in 35 patients (3.3%; stroke:2.1%) at a median follow-up of 12 (3-23) months. The predictors of late CVEs were chronic AF (HR:2.84, 95%CI:1.46-5.53), peripheral vascular disease (HR: 2.02, 95%CI:1.02-3.97) and prior cerebrovascular disease (HR:2.04, 95%CI:1.01-4.15). Major stroke was associated with 30-day (OR 7.43, 95%CI:2.45-22.53) and late (HR:1.75, 95%CI:1.01-3.04) mortality.
Conclusions—In a large cohort of patients undergoing TAVI, the rate of acute and subacute CVEs was 2.7% and 2.4%, respectively. While balloon postdilation and valve dislodgment/embolization were the predictors of acute CVEs, NOAF determined a higher risk for subacute events. Late events were mainly determined by a history of chronic AF, peripheral and cerebrovascular disease. The occurrence of major stroke was associated with an increased early and late mortality. These results provide important insights for the implementation of preventive measures for CVEs following TAVI.
- aortic valve stenosis
- percutaneous valve implantation
- percutaneous valve replacement
- transcutaneous aortic valve implantation
- Received April 9, 2012.
- Accepted October 15, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited