The Incidence and Predictors of Early- and Mid-Term Clinically Relevant Neurological Events After Transcatheter Aortic Valve Replacement in Real-World Patients

被引:68
作者
Bosmans, Johan [1 ]
Bleiziffer, Sabine [2 ]
Gerckens, Ulrich [3 ]
Wenaweser, Peter [4 ]
Brecker, Stephen [5 ]
Tamburino, Corrado [6 ]
Linke, Axel [7 ]
机构
[1] Univ Antwerp Hosp, B-2650 Edegem, Belgium
[2] Tech Univ Munich, German Heart Ctr, D-80290 Munich, Germany
[3] Gemeinschaftskrankenhaus, Bonn, Germany
[4] Univ Hosp Bern, CH-3010 Bern, Switzerland
[5] St George Hosp, London, England
[6] Univ Catania, Ferrarotto Hosp, Catania, Italy
[7] Univ Leipzig, Ctr Heart, D-04109 Leipzig, Germany
关键词
aortic stenosis; self-expanding transcatheter aortic valve; stroke; transient ischemic attack; STENOSIS; IMPLANTATION; SURGERY;
D O I
10.1016/j.jacc.2015.05.025
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND Transcatheter aortic valve replacement (TAVR) enables treatment of high-risk patients with symptomatic aortic stenosis without open-heart surgery; however, the benefits are mitigated by the potential for neurological events. OBJECTIVES This study sought to determine the timing and causes of clinically relevant neurological events after self-expandable TAVR. METHODS We enrolled 1,015 patients, of whom 996 underwent TAVR with a self-expandable system at 44 TAVR-experienced centers in Europe, Colombia, and Israel. Neurological events were evaluated for 3 distinct time periods: periprocedural (0 to 1 days post TAVR); early (2 to 30 days); and late (31 to 730 days). In this real-world study, neurological events were first referred to the site neurologist and then reviewed by an independent neurologist. RESULTS The overall stroke rate was 1.4% through the first day post-procedure, 3.0% at 30 days, and 5.6% at 2 years. There were no significant predictors of periprocedural stroke or stroke/transient ischemic attack (TIA) combined. Significant predictors of early stroke were acute kidney injury (p = 0.03), major vascular complication (p = 0.04), and female sex (p = 0.04). For stroke/TIA combined, prior atrial fibrillation (p = 0.03) and major vascular complication (p = 0.009) were predictive. Coronary artery bypass graft surgery was the only significant predictor of late stroke (p = 0.007) or late stroke/TIA (p = 0.06). CONCLUSIONS Treatment of high-risk patients with aortic stenosis using a self-expandable system was associated with a low stroke rate at short-and long-term follow-up. Multivariable predictors of clinically relevant neurological events differed on the basis of the timing after TAVR. (C) 2015 by the American College of Cardiology Foundation.
引用
收藏
页码:209 / 217
页数:9
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