March 11, 2020
Study Evaluates Late Cerebrovascular Events After TAVR
March 11, 2020—Online in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions, Guillem Muntané-Carol, MD, et al published findings from a multicenter study that sought to determine the incidence, clinical characteristics, associated factors, and outcomes of late cerebrovascular events (LCVEs) (> 30 days postprocedure) after transcatheter aortic valve replacement (TAVR).
In their conclusions, the investigators stated, “Late stroke was disabling in most cases and associated with dreadful early and midterm outcomes.” They found that an increased risk of LCVEs, which were ischemic in most cases, was generally caused by factors independent of valve thrombosis or degeneration.
The study was composed of 3,750 consecutive patients (mean age, 80 ± 8 years; sex, 50.5% women) who underwent TAVR and survived beyond 30 days. LCVEs were defined according to Valve Academic Research Consortium-2 criteria.
In JACC: Cardiovascular Interventions, the investigators reported the following:
- LCVEs occurred in 192 (5.1%) patients after a median follow-up of 2 (1–4) years.
- LCVEs were stroke in 80.2% of patients and transient ischemic attack in 19.8%.
- The origin of late stroke was ischemic, hemorrhagic, and undetermined in 80.5%, 18.8%, and 0.7% of patients, respectively.
- Independent factors associated with late ischemic stroke/transient ischemic attack included older age, previous cerebrovascular disease, higher mean aortic gradient at baseline, the occurrence of stroke during the periprocedural TAVR period, and the lack of anticoagulation (novel oral anticoagulants or vitamin K antagonists) post-TAVR (P < .05 for all).
- Echocardiographic data at the time of the LCVE showed no signs of valve thrombosis or degeneration in the vast majority (97%) of patients.
- Late stroke was disabling in 107 (69.5%) patients (ischemic, 68%; hemorrhagic, 79%), and associated with an in-hospital mortality rate of 29.2%.