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Predictors of Stroke After TAVR
Study Questions:
What are predictors of stroke following transcatheter aortic valve replacement (TAVR)?
Methods:
This systematic review and meta-analysis examined rates of stroke at 30 days following TAVR from 64 studies including 72,318 patients. Analysis of baseline predictors was performed using 28 studies, while 41 studies were used in the analysis of procedural variables.
Results:
The median rate of stroke was 4%. Variables associated with risk of stroke included male gender (risk ratio [RR], 0.82; p = 0.02), chronic renal disease (RR, 1.29; p = 0.03), new atrial fibrillation after TAVR (RR, 1.78; p = 0.009), and procedures performed in the initial half of site experience (RR, 1.55; p = 0.003). Valve type (p = 0.26) and approach (p = 0.81) did not predict risk of stroke, while balloon post-dilation had a nonsignificant trend to increased stroke (RR, 1.43; p = 0.07).
Conclusions:
Female gender, chronic renal disease, new atrial fibrillation following TAVR, and lower site experience were associated with increased risk of stroke following TAVR.
Perspective:
Stroke remains one of the most serious potential complications of TAVR, and this study helps identify patients at increased risk following this procedure. These results endorse careful observation following TAVR to identify atrial fibrillation and consideration of prompt initiation of anticoagulation therapy. The observation of increased stroke risk during earlier site experience may represent improved outcomes based on procedural experience, although it may also represent confounding factors such as improved devices and procedures as well as better patient selection.
Keywords: Aortic Valve Stenosis, Atrial Fibrillation, Cardiac Surgical Procedures, Heart Valve Diseases, Renal Insufficiency, Chronic, Risk, Stroke, Transcatheter Aortic Valve Replacement
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