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Stroke Risk After Bioprosthetic Aortic Valve Replacement in Aortic Stenosis: Systematic Review and Meta-Analysis
Tarek Bou Dargham1, Sara Hassani2, Brian C Mac Grory3
1Department of Neurosurgery (T.B.D.), Duke University School of Medicine, Durham, NC.
Stroke
|March 20, 2026
Summary
Stroke risk after bioprosthetic aortic valve replacement (AVR) for aortic stenosis (AS) is significant. Transcatheter AVR (TAVR) showed lower early stroke risk compared to surgical AVR, with similar long-term rates.
Area of Science:
- Cardiology
- Neurology
- Biomedical Engineering
Background:
- Stroke is a serious complication following bioprosthetic aortic valve replacement (AVR) for severe aortic stenosis (AS).
- Accurate stroke rate estimation post-AVR is crucial for patient management and prognosis.
- Understanding stroke risk beyond the periprocedural period is essential for transcatheter AVR (TAVR), surgical AVR, and valve-in-valve (ViV) procedures.
Purpose of the Study:
- To determine the proportion of ischemic stroke in adults over 18 after bioprosthetic AVR for AS.
- To provide updated stroke risk estimates beyond the early periprocedural period.
- To compare stroke rates between TAVR and surgical AVR.
Main Methods:
- Systematic literature search of MEDLINE, Embase, and Web of Science up to March 2024.
- Inclusion of studies reporting stroke rates at least 90 days post-bioprosthetic AVR for severe AS, including ViV.
- Pooled proportion estimation for TAVR and ViV; mixed-effects models for TAVR vs. surgical AVR comparison.
Main Results:
- In native AS, pooled 30-day stroke post-TAVR was 3.0%; 1-year stroke was 5.0%.
- TAVR showed significantly lower 30-day stroke odds versus surgical AVR (OR 0.73).
- No significant stroke proportion difference between TAVR and surgical AVR at 1, 2, or 5 years; ViV 30-day and 1-year stroke rates were 2.0% and 3.0% respectively.
Conclusions:
- This meta-analysis offers updated stroke risk estimates post-bioprosthetic AVR for AS, extending beyond the early period.
- Further research is needed on long-term stroke causes and the impact of antithrombotic therapies.
- Investigating the effects of AVR procedures on cognitive function is recommended.
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