Prognostic Impact of Neurologic Events After Transcatheter Aortic Valve Implantation According to Their Timing

Neurologic events (NEs) remain a feared complication after transcatheter aortic valve implantation (TAVI). The relationship between NE timing and prognosis remains uncertain. In this study we aimed to assess the impact of NE on mortality according to NE timing.

Patients undergoing TAVI at 18 European centers between 2007 and 2022, included in the Transfusion Requirements in Transcatheter Aortic Valve Implantation (NCT03740425) registry, were stratified according to the timing of NEs. NEs were defined as periprocedural (≤ 30 days) or non-periprocedural (> 30 days) according to the Valvular Academic Research Consortium-3 criteria. The primary endpoint was 2-year all-cause mortality as assessed using restricted mean survival time.

Among 10,079 patients undergoing TAVI, 263 (2.6%) experienced an NE over a median follow-up of 20.6 (interquartile range 9.8-38.3) months after TAVI. A total of 171 NEs (65.0%) were periprocedural and 92 (35.0%) non-periprocedural. Fatal stroke accounted for 6.4% of periprocedural NEs and 40.2% of non-periprocedural NEs. Median time from NE to death was 20.4 (9.4-38.1) months. Both types of NEs were associated with significantly reduced 2-year survival time: -164.7 days for periprocedural NEs and -360.5 for non-periprocedural NEs (P for trend = 0.029). The adverse prognostic impact of NE increased progressively over time.

In this large multicenter registry, all types of NEs after TAVI were associated with reduced midterm survival. NEs that occurred later had the greatest detrimental effect on life expectancy, showing a significant temporal gradient across NE categories. Further studies are warranted to evaluate preventive strategies and long-term monitoring approaches.