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Stroke Complicating Infective Endocarditis After Transcatheter Aortic Valve Replacement
David Del Val1, Mohamed Abdel-Wahab2, Norman Mangner3
1Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Journal of the American College of Cardiology
|May 7, 2021
Summary
Stroke is a significant complication of infective endocarditis (IE) after transcatheter aortic valve replacement (TAVR), affecting 10% of patients. Key risk factors include prior stroke and vegetation size, with stroke increasing mortality and not benefiting from surgical intervention.
Area of Science:
- Cardiology
- Neurology
- Infectious Diseases
Background:
- Stroke is a common complication of infective endocarditis (IE).
- Data on stroke complicating IE after transcatheter aortic valve replacement (TAVR) is limited.
Purpose of the Study:
- To determine the incidence, risk factors, clinical characteristics, management, and outcomes of stroke in patients with IE post-TAVR.
Main Methods:
- Analysis of data from the Infectious Endocarditis after TAVR International Registry (569 patients).
- Comparison of patients with stroke (S-IE) versus no stroke (NS-IE) during IE hospitalization.
Main Results:
- 10% of patients experienced stroke during IE hospitalization.
- Risk factors for stroke included prior stroke, moderate-to-severe residual aortic regurgitation, balloon-expandable valves, early IE post-TAVR, and large vegetations (>8 mm).
- Stroke significantly increased in-hospital (54.4% vs. 28.7%) and 1-year mortality (66.3% vs. 45.6%).
Conclusions:
- Stroke occurs in 1 in 10 IE patients post-TAVR.
- Specific risk factors predict stroke, which is associated with higher mortality.
- Surgical treatment did not improve outcomes in stroke patients.
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