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Stroke is an important complication of transcatheter replacement of aortic valve (TAVR). Carotid artery stenosis (CAS) represents a major risk factor of cerebrovascular disease. In this study we evaluate the outcomes associated with CAS in patients undergoing TAVR.
The study population was extracted from National Readmission Data (NRD) 2014 using International Classification of Diseases ninth (ICD-9) codes for TAVR, CAS and periprocedural complications. Study endpoints included stroke, all-cause in-hospital mortality, length of index hospital stay (LOS), mechanical complications of heart valve prosthesis (including paravalvular leak), acute myocardial infarction (AMI), acute kidney injury (AKI), bleeding, vascular access complications (VAC), need for permanent pacemaker implantation (PPM) and 30-day readmission rates. Propensity matching was used to extract a matched control group TAVR-C to TAVR-CAS group.
A total of 673 patients were included from unweighted (1448 weighted) in each group. Both groups were comparable in terms of patients’ baseline characteristics and comorbidities. Average age was 80.8 years, and 65% were male. There was no significant difference between TAVR-CAS and TAVR-C in terms of stroke (7.0% versus 4.9%, p=0.10), all-cause in-hospital mortality (3.7% versus 2.7%, p=0.29), mean LOS (8.4 versus 8.5 days, p=0.85), mechanical complications of heart valve prosthesis (1.8% versus 2.7%, p=0.27), AMI (3.7% versus 3.0%, p=0.45), AKI (14.4% versus 16.6%, p=0.70), bleeding (35.6% versus 34.1%, p=0.56), VAC (1.4% versus 1.2%, p=0.81), PPM (0.2% versus 0.5%, p=0.32) and 30-day readmission rates (20.6% versus 17.9%, p=0.24).
TAVR-CAS was associated with comparable outcomes to TAVR-C in terms of stroke, all-cause in-hospital mortality, LOS, mechanical complications of heart valve prosthesis, AMI, AKI, bleeding, VAC, PPM and 30-day readmission rates.