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Stroke Risk After TAVR: Balloon-Expandable vs Self-Expanding Valves in Community Practice
Sant Kumar1, David Elison2, Ashish Pershad3
1Creighton University School of Medicine, Phoenix, Arizona, USA; St. Joseph Hospital and Medical Center, Phoenix, Arizona, USA.
Insights
Transcatheter aortic valve replacement (TAVR) valve type did not impact stroke risk within one year. Clinical factors like age and prior stroke history were the main predictors of stroke after TAVR.
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.
Background:
Stroke is a serious complication after transcatheter aortic valve replacement (TAVR), yet contemporary data from community hospital practice are limited.
Objectives:
The purpose of this study was to evaluate the association between valve type and the risk of stroke within 1 year after contemporary TAVR in community practice.
Methods:
We analyzed patients who underwent TAVR across CommonSpirit Health hospitals from January 2021 to February 2023 using data from the Society of Thoracic Surgeons (STS)/American College of Cardiology Transcatheter Valve Therapy Registry. Valve type was categorized as balloon-expandable valves or self-expanding valves (SEV). The primary outcome was stroke within 1 year. Kaplan-Meier methods were used to compare stroke-free survival between valve types. Baseline differences were adjusted using inverse probability of treatment weighting. Independent predictors of stroke were identified using weighted time-to-event models.
Results:
A total of 6,663 patients underwent TAVR during the study period; 5,445 (81.7%) received balloon-expandable valve, and 1,218 (18.3%) received SEV. More females received a SEV (56.7% vs 37.5%; P < 0.001). The STS risk score (4.5 ± 3.8 vs 4.0 ± 3.5; P < 0.001) was higher in the SEV group. A total of 87 (1.3%) patients experienced stroke within the study period. The primary endpoint of stroke-free survival at 1 year was not different between valve types (log-rank P = 0.448). After inverse probability of treatment weighting adjustment, valve type was not associated with stroke (adjusted HR: 1.54; 95% CI: 0.79-2.68; P = 0.294). Age, lower body mass index, prior stroke, STS risk, and alternative access were associated with stroke.
Conclusions:
In this registry of patients receiving TAVR, valve type did not predict stroke at 1 year. The predominant drivers of stroke were clinical variables: age, STS risk, and a history of stroke.
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