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The incidence of stroke post-transcatheter aortic valve replacement (TAVR) has remained constant over the first 5 years in the US, the TVT Registry showed.
The 30-day rate of stroke was constant in the large femoral access cohort (P= 0.47 for trend) or among all the patients (P= 0.22 for trend) who underwent Samir Kapadia, MD, of the Cleveland Clinic, and colleagues in JAMA.
The rate of stroke was 2.3% and 0.4% for transient ischemic attacks (TIA) in the 30 days following TAVR, the investigators found, calling the findings "a framework for future efforts to reduce post-TAVR stroke rates."
These rates in a predominantly high- or extreme-risk population were lower than expected, which had 30-day stroke rates of 3.4% to 6.7%, noted Steven Messé, MD, of the University of Pennsylvania in Philadelphia, and Gorav Ailawadi, MD, of the University of Virginia in Charlottesville, in an accompanying editorial.
However, the registry likely underestimated strokes for a number of reasons, they suggest.
Patients who have been treated, and have been gaining experience, the editorialists noted that "the continual expansion of TVT with new inexperienced sites," the less experienced proceduralists , or both may have offset this benefit overall. "
Stephen Bailey, MD, of the Allegheny Health Network in Pittsburgh, who was not involved in the study, also noted a number of findings in the clinical findings of TAVR .
"I think it will be a surprise to be more in the field, because I think it would be a matter of course, have gone up, that we have done better and that we are doing better, "Bailey told MedPage Today.
TAVR, with 68.4% of patients who had a stroke within 3 days and 48.9% within 1 day, the researchers wrote.
The majority of strokes and TIA occurred within the first few days of TAVR, indicating that William Zoghbi, MD, of the Houston Methodist DeBakey Heart & Vascular Center in Texas, who was not involved in the study.
"- To me, it is possible that these factors can be investigated" – the procedure itself, the catheters, the aortic valve, the aorta and its structure, the device , and other coexisting conditions like atrial fibrillation, Zoghbi told MedPage Today.
So far, embolic filter-protected transcatheter aortic valve replacement has been shown to be effective.
Kapadia's group evaluated 101,430 patients who underwent TAVR from November 9, 2011 through May 31, 2017 at 521 hospitals using the Society of Thoracic Surgeons / American College of Cardiology Transcatheter Valve Therapies (TVT) Registry. Among them, 47.1% were women, and the median age was 83.
The analysis included both femoral- and nonfemoral-access TAVR. The 30-day stroke risk did not vary by oral anticoagulant or dual antiplatelet therapy.
The rate of 30-day mortality was significantly lower among patients with a stroke than one (3.7% vs 16.7%; P <0.001).
Limitations of the study included its retrospective design, voluntary site-reported data on neurologic events, and no requirement for regular neuroimaging of asymptomatic patients or neurologic evaluation following TAVR.
Kapadia reported no disclosures.
Messé reported relationships with Yale University Cardiovascular Research Group, W. L. Gore and Associates, and Claret Medical.
Ailawadi reported with Admedus, Edwards Lifesciences, Abbott, and Medtronic.
Zoghbi reported no disclosures.
1969-12-31T19: 00: 00-0500
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