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Published on: June 3, 2018
Transcatheter aortic valve implantation and cerebrovascular accidents
Stefan Stortecky1, Peter Wenaweser, Stephan Windecker
1Department of Cardiology, Bern University Hospital, Bern, Switzerland.
Insights
Transcatheter aortic valve implantation (TAVI) can cause cerebrovascular events, impacting patient outcomes. This review covers TAVI complication incidence, mechanisms, and prevention strategies for improved patient prognosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Neurology
Background:
- Transcatheter aortic valve implantation (TAVI) is a key treatment for severe aortic stenosis.
- Cerebrovascular accidents (CVAs) are significant periprocedural complications of TAVI.
- Improving TAVI technology and techniques are ongoing.
Purpose of the Study:
- To review the incidence of cerebrovascular events post-cardiovascular procedures.
- To explore pathophysiological mechanisms of TAVI-related CVAs.
- To discuss preventive and acute management strategies for these events.
Main Methods:
- Literature review of cerebrovascular events after cardiovascular procedures.
- Analysis of pathophysiological mechanisms.
- Synthesis of current preventive and management insights.
Main Results:
- Cerebrovascular events remain a concern despite technological advancements in TAVI.
- These events can negate the benefits of TAVI on prognosis and quality of life.
- Understanding mechanisms is crucial for developing effective strategies.
Conclusions:
- Effective prevention and management of cerebrovascular events are vital for optimizing TAVI outcomes.
- Further research into mitigating CVA risk during TAVI is warranted.
- Addressing CVAs is essential for improving patient prognosis and quality of life after TAVI.
Abstract:
Transcatheter aortic valve implantation (TAVI) is an evidence-based treatment alternative for selected high-risk patients with symptomatic severe aortic stenosis as acknowledged in the most recent edition of the ESC Guidelines on Valvular Heart Disease 2012. However, periprocedural complications and in particular cerebrovascular accidents remain a matter of concern. While transcatheter heart valve technology continuously improves and the development of novel and even less invasive implantation techniques is on-going, cerebrovascular events complicating TAVI may abrogate the usual improvement in terms of prognosis and quality of life. This article describes the incidence of cerebrovascular events after cardiovascular procedures, provides an overview of the pathophysiological mechanisms as well as the impact on outcomes and provides some insights into preventive strategies as well as the acute management of these events.
