Stroke Risk After TAVR: Balloon-Expandable vs Self-Expanding Valves in Community Practice

Area of Science:

• Cardiology
• Interventional Cardiology
• Health Services Research

Background:

• Stroke is a significant complication following transcatheter aortic valve replacement (TAVR).
• Limited contemporary data exists on stroke risk after TAVR in community hospital settings.
• Understanding stroke risk factors is crucial for improving patient outcomes.

Purpose of the Study:

• To investigate the association between different TAVR valve types and the risk of stroke within one year.
• To analyze contemporary TAVR data from community practice to inform clinical decision-making.
• To identify key predictors of stroke in patients undergoing TAVR.

Main Methods:

• Analysis of 6,663 patients undergoing TAVR between January 2021 and February 2023.
• Categorization of valves into balloon-expandable and self-expanding valve (SEV) types.
• Utilized Kaplan-Meier methods and inverse probability of treatment weighting for robust statistical analysis.

Main Results:

• No significant difference in 1-year stroke-free survival between balloon-expandable and self-expanding valves (P = 0.448).
• Adjusted analysis confirmed no association between valve type and stroke risk (aHR: 1.54; P = 0.294).
• Independent predictors of stroke included age, lower BMI, prior stroke, STS risk score, and alternative access.

Conclusions:

• TAVR valve type is not a predictor of stroke within one year post-procedure.
• Clinical variables such as age, STS risk score, and history of stroke are the primary drivers of stroke risk.
• Focusing on patient-specific clinical factors is essential for stroke risk mitigation after TAVR.