Abstract
Background
Transcatheter aortic valve implantation (TAVI) has become the preferred alternative to surgical valve replacement in high risk patients with severe symptomatic aortic stenosis. Stroke is still a feared complication following TAVI, associated with increased mortality and severe impact on patients' daily living. Despite technological development and knowledge improvement, cerebrovascular events (CVE) are still not predictable so far and simple risk scores are lacking. The expansion of TAVI therapy towards younger and lower risk populations will force us to discover the mechanisms determining stroke after TAVI.
Purpose
This study aimed to evaluate different patient and procedure related factors for prediction of stroke after TAVI, especially regarding severity of aortic calcification.
Methods
From May 2011 to January 2018 a total of 1365 patients underwent TAVI with a balloon-expandable (32.4%) or self-expandable (67.6%) valve at our institution. 60 patients (4.4%) suffered from new neurological impairment in terms of CVE after TAVI during hospital stay (mean 11.2±6.7 days). We performed propensity score matching (1:10) to balance baseline characteristics between patients with and without stroke following TAVI, resulting in 56 patients with in-hospital stroke and 521 patients without neurological disorder. Stroke was defined according to the Valve Academic Research Consortium recommendations (VARC-2).
Results
Body surface area (stroke vs. control: 2.73±0.27 vs. 2.81±0.29 m2; p=0.0451) and prior stroke (stroke vs. control: 17.86% vs. 8.64%; p=0.0256) were patient related predictors of stroke after TAVI during in-hospital stay. While aortic valve Agatston score (stroke vs. control: 2475±1593 vs. 2060±1344 AU; p=0.0383) and ascending thoracic aorta Agatston score (stroke vs. control: 986.5±1989 vs. 505.2±1018 AU; p=0.0045) showed to be good predictors, peripheral vascular diseases were not associated with stroke (stroke vs. control: 35.7% vs. 31.3%; p=0.4986). A procedural predictor of acute CVE was extended procedure time (stroke vs. control: 101.8±39.6 vs. 90.0±31.3 hours; p=0.0105). Finally, stroke after TAVI resulted in clearly prolonged hospital stay (stroke vs. control: 16.1±9.0 vs. 10.7±6.2 days; p<0.0001).
Conclusion
The severity of aortic valve and ascending thoracic aorta calcification predicts stroke after TAVI as well as extended procedure time, possibly due to increased mechanical intravascular manipulation by prolonged catheterisation. These correlations could guide us in identifying those patients who are most likely to benefit from transcatheter cerebral embolic protection devices.
P4496Changes in valvulo-arterial impedance after transcatheter aortic valve implantation according to calcification burden of thoracic aorta
