Expected Surgical Risk and the Risk of Stroke and Brain Injury After Transcatheter Aortic Valve Replacement: A...

Area of Science:

• Cardiology
• Neurology
• Medical Imaging

Background:

• The Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) is used for risk stratification in transcatheter aortic valve replacement (TAVR).
• The predictive value of STS-PROM for stroke and neurocognitive outcomes post-TAVR remains uninvestigated.
• This study evaluates the association between STS-PROM and clinical outcomes, including stroke, brain injury, and cognitive decline after TAVR.

Purpose of the Study:

• To determine if the STS-PROM score predicts stroke and neurocognitive outcomes in patients undergoing TAVR.
• To assess the relationship between surgical mortality risk and post-TAVR neurological and cognitive function.

Main Methods:

• Pooled data from 4 prospective trials (DEFLECT III, NeuroTAVR, REFLECT I, REFLECT II) involving 537 patients undergoing TAVR.
• Included protocol-mandated predischarge diffusion-weighted magnetic resonance imaging (DW-MRI) and serial cognitive/neurologic assessments.
• Compared outcomes across low (STS <4), intermediate (STS 4-8), and high (STS >8) risk groups, with adjudication by a clinical events committee.

Main Results:

• High-risk patients (STS >8) exhibited increased 30-day rates of all-cause/cardiovascular mortality, myocardial infarction, acute kidney injury, bleeding, and vascular complications.
• However, rates of stroke, disabling stroke, DW-MRI-defined brain injury, and cognitive decline were similar across all STS risk categories.
• 253 patients were low risk, 198 intermediate risk, and 86 high risk.

Conclusions:

• The STS-PROM score is not a reliable predictor of stroke, cognitive decline, or acute brain injury following TAVR.
• While STS-PROM effectively identifies patients at higher risk for mortality and complications, it does not stratify neurological risk.