Author + information
- Received July 24, 2019
- Revision received November 4, 2019
- Accepted November 12, 2019
- Published online April 6, 2020.
- Guillem Muntané-Carol, MDa,
- Marina Urena, MDb,
- Antonio Munoz-Garcia, MDc,
- Remigio Padrón, MDd,
- Enrique Gutiérrez, MDe,
- Ander Regueiro, MDf,
- Vicenç Serra, MDg,
- Giulianna Capretti, MDb,
- Dominique Himbert, MDb,
- Cesar Moris, MDd,
- Manel Sabaté, MDf,
- Bruno Garcia del Blanco, MDg,
- Alfredo Nunes Ferreira-Neto, MDa,
- Mélanie Coté, MSca,
- Quentin Fischer, MDb,
- Thomas Couture, MSa,
- Dimitri Kalavrouziotis, MDa and
- Josep Rodés-Cabau, MDa,∗ ()
- aQuebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
- bAssistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
- cHospital Universitario Virgen de la Victoria, Málaga, Spain
- dHospital Universitario Central de Asturias, Asturias, Spain
- eHospital General Universitario Gregorio Marañón, Madrid, Spain
- fInstitut Clínic Cardiovascular, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- gHospital Universitari Vall d’Hebron, Barcelona, Spain
- ↵∗Address for correspondence:
Dr. Josep Rodés-Cabau, Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City G1V4G5, Canada.
Objectives This study sought to determine the incidence, clinical characteristics, associated factors, and outcomes of late cerebrovascular events (LCVEs) (>30 days post-procedure) following transcatheter aortic valve replacement (TAVR).
Background Scarce data exist on LCVEs following TAVR.
Methods This was a multicenter study including 3,750 consecutive patients (mean age, 80 ± 8 years; 50.5% of women) who underwent TAVR and survived beyond 30 days. LCVEs were defined according to the Valve Academic Research Consortium 2 (VARC 2) criteria.
Results LCVEs occurred in 192 (5.1%) patients (stroke, 80.2%; transient ischemic attack, 19.8%) after a median follow-up of 2 (1 to 4) years. Late stroke was of ischemic, hemorrhagic, and undetermined origin in 80.5%, 18.8%, and 0.7% of patients, respectively. Older age, previous cerebrovascular disease, higher mean aortic gradient at baseline, the occurrence of stroke during the periprocedural TAVR period, and the lack of anticoagulation (novel oral anticoagulants or vitamin K antagonists) post-TAVR were independent factors associated with late ischemic stroke/transient ischemic attack (p < 0.05 for all). Echocardiographic data at the time of the LCVE showed no signs of valve thrombosis or degeneration in the vast majority (97%) patients. Late stroke was disabling in 107 (69.5%) patients (ischemic, 68%; hemorrhagic, 79%), and associated with an in-hospital mortality rate of 29.2%.
Conclusions LCVEs occurred in 5.1% of TAVR recipients after a median follow-up of 2 years. LCVEs were ischemic in most cases, with older age, previous cerebrovascular events, higher mean aortic gradient at baseline, the occurrence during the periprocedural TAVR period, and lack of anticoagulation (but not valve thrombosis/degeneration) determining an increased risk. Late stroke was disabling in most cases and associated with dreadful early and midterm outcomes.
Dr. Muntané-Carol is supported by a research grant from the Fundación Alfonso Martín Escudero (Madrid, Spain). Dr. Requeiro received proctor and speaker fees from Abbott. Dr. Himbert is a proctor for Edwards Lifesciences. Dr. Sabaté is a consultant for Abbott Vascular and Ivascular. Dr. Moris is a proctor for Medtronic. Dr. Rodés-Cabau holds the Research Chair “Fondation Famille Jacques Larivière” for the Development of Structural Heart Disease Interventions; and has received institutional research grants from Medtronic, Boston Scientific, and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 24, 2019.
- Revision received November 4, 2019.
- Accepted November 12, 2019.
- 2020 American College of Cardiology Foundation
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