Long-term neurological outcomes after transcatheter aortic valve replacement in high-volume cardiovascular care...

Aortic stenosis (AS) is the most common valvular pathology in Europe and North America, with its prevalence rising due to age-related degeneration and calcification of the aortic valve. The global number of transcatheter aortic valve replacement (TAVR) procedures is rapidly increasing. Nevertheless, the ischemic cerebrovascular events remain among the most significant complications of this procedure. This study aimed to assess the long-term incidence of neurological events and identify the most powerful predictors of stroke following TAVR in a high-volume cardiovascular care center.

705 patients who underwent TAVR between January 2016 and September 2022, with a median follow-up of 60 months were analyzed. Baseline patient characteristics, procedural data, and long-term neurological outcomes were evaluated.

At five years the cumulative incidence of any neurological events, strokes and disabling strokes reached 28.5%, 20.3% and 13.2%, respectively. Periprocedural strokes occurred in 1.4% of patients. The multivariable analysis performed was aimed at identifying the relationship between a range of clinical and procedural variables and the incidence of stroke within five years following TAVR.

The findings highlight the importance of long-term neurological follow-up after TAVR, as stroke mechanisms evolve over time - from periprocedural embolization to thrombus formation or chronic conditions like frailty and atherosclerosis. Future research should focus on more targeted stroke prevention and long-term management strategies enhancing safety for the TAVR recipient population.