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Transcatheter Pulmonary Valve Replacement from Autologous Pericardium with a Self-Expandable Nitinol Stent in an Adult Sheep Model
Published on: June 8, 2022
Self-expandable transcatheter aortic valve replacement is associated with frequent periprocedural stroke detected by
Keiko Kajio1, Kazuki Mizutani1, Masahiko Hara2
1Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
Background:
Little evidence is available regarding the risk of peri-procedural stroke detected by diffusion-weighted magnetic resonance imaging (DW-MRI) after transcatheter aortic valve replacement (TAVR). Our purpose was to evaluate stroke risk after TAVR using DW-MRI by enrolling consecutive patients who underwent transfemoral TAVR and post-procedural DW-MRI.
Methods:
We prospectively enrolled 113 consecutive patients who underwent transfemoral TAVR and post-procedural DW-MRI. We used balloon-expandable valves as first-line therapy and selected self-expandable valves only for patients with narrow sinotubular junctions or annuli. We set the primary endpoint as the number of high intensity areas (HIA) detected by DW-MRI regardless of the size of the area. To evaluate the risks of the primary endpoint, we employed a multivariable linear regression model, setting the primary endpoint as an objective variable and patient and clinical backgrounds as explanatory variables.
Results:
Median patient age was 84 years, and 36.3% were men. Ninety-three patients underwent balloon-expandable TAVR and 20 underwent self-expandable TAVR. Symptomatic stroke occurred in 6 (5.3%) whereas asymptomatic stroke occurred in 59 (52.2%) patients. The incidence of symptomatic and total stroke was higher in patients who underwent self-expandable TAVR than those who underwent balloon-expandable TAVR (30.0% vs. 0.0%, p<0.001 and 90.0% vs. 50.5%, p=0.001, respectively). A multivariable linear regression model demonstrated an increased primary endpoint when self-expandable TAVR was performed (p<0.001). The other covariates had no significant relationship to the primary endpoint. Akaike information criterion-based stepwise statistical model selection revealed that valve type was the only explanatory variable for the best predictive model.
Conclusions:
Self-expandable valves were associated with increased numbers of HIA on DW-MRI after TAVR in patients with severe aortic stenosis.
Insights
Self-expandable valves increase stroke risk detected by diffusion-weighted MRI after transcatheter aortic valve replacement (TAVR). Balloon-expandable valves are associated with fewer high-intensity areas on DW-MRI post-TAVR.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Limited data exists on peri-procedural stroke risk after TAVR detected by DW-MRI.
- Transfemoral TAVR is a common procedure for severe aortic stenosis.
Purpose of the Study:
- To evaluate stroke risk after TAVR using DW-MRI.
- To identify factors associated with increased stroke risk post-TAVR.
Main Methods:
- 113 consecutive patients undergoing transfemoral TAVR were prospectively enrolled.
- Diffusion-weighted MRI (DW-MRI) was used to detect high-intensity areas (HIA) post-procedure.
- Multivariable linear regression analyzed the relationship between valve type and HIA.
Main Results:
- Self-expandable TAVR was associated with a significantly higher incidence of symptomatic and total stroke compared to balloon-expandable TAVR.
- The number of HIA on DW-MRI was significantly increased in patients receiving self-expandable valves.
- Valve type was the sole significant predictor of HIA in the best predictive model.
Conclusions:
- Self-expandable valves are linked to a higher number of DW-MRI detected HIA post-TAVR.
- This suggests a potentially higher stroke risk with self-expandable valves in TAVR patients.
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