Abstract T MP115: Cerebral Ischemic Events Associated with Transcatheter Aortic Valve Replacement (TAVR): A Systematic Review
Introduction: Transcatheter aortic valve replacement (TAVR) has recently emerged as a treatment option in patients with symptomatic severe aortic stenosis. Cerebral ischemic events are recognized events associated with TAVR, however, a detailed analysis of such events is not performed.
Methods: We performed a literature search to identify studies reporting outcome data at different time intervals following TAVR (peri-procedural/30-days, 1, 2, and 3 yrs). Data on the incidence of stroke/TIA was extracted from studies that used the Valve
Academic Research Consortium criteria and a comparison of stroke/TIA incidence between TAVR vs. surgical AVR, transfemoral (TF) vs. transapical (TA) approach, and self-expanding vs. balloon expanding valves is reported.
Results: Peri-procedural stroke/TIA incidence after TAVR ranged from 1.6% to 5.5%. Incidence rates from the registries and meta-analyses were lower (2.3 - 2.8%) than those reported in the randomized clinical trials (RCTs) (4.6 - 5.5%). At 1-yr, pooled incidence rates from meta-analyses and RCTs ranged from 3.8 - 4.5% and 7.6 - 8.8%, respectively. Incidence at 2 and 3 yrs was 11.2% and 8.2% as reported in the RCT.
Meta-analyses revealed no difference in incidence rates between TAVR and SAVR at 30-d or 1 yr, but one RCT suggested a higher incidence of stroke/TIA with
TAVR at both these intervals. At 3 yrs, the stroke/TIA incidence incidence rates were similar between TAVR and SAVR. No difference in stroke incidence between the TF-TAVR and TA-TAVR approaches or the valve type was noted.
Conclusions: In comparison to SAVR, existing data indicates a marginally higher incidence of stroke with TAVR during the peri-procedural period. Inconsistencies were noted in long term clinical outcomes including stroke/TIA incidence with TAVR. Future research should focus on patient selection, improvement in valve technology and procedural techniques to minimize the observed risk.
Author Disclosures: N.A. Herial: None. N.S.Y. Mohammad: None. M. Chughtai: None. A.I. Qureshi: None.
- © 2015 by American Heart Association, Inc.