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Updated: Jul 4, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Predictors of early cerebrovascular events after transcatheter aortic valve replacement: a systematic review and
Yi Zhang1,2,3, Ying Zhang1,2,3, Yi-Jun Yao1,2,3
1Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
Insights
Predicting early cerebrovascular events after transcatheter aortic valve replacement (TAVR) is crucial. This study identified key patient and procedure factors to improve risk prediction and management strategies for TAVR patients.
Area of Science:
- Cardiology
- Neurology
- Interventional Cardiology
Background:
- Early cerebrovascular events (CVEs) are severe complications following transcatheter aortic valve replacement (TAVR).
- Predictive and preventive strategies for these early CVEs remain underdeveloped.
- A systematic review and meta-analysis were conducted to identify key predictors.
Purpose of the Study:
- To identify significant patient-level and procedure-level predictors of early CVEs within 30 days post-TAVR.
- To inform the development of a comprehensive risk prediction model for TAVR.
- To enhance clinical risk management strategies for TAVR procedures.
Main Methods:
- Systematic review and meta-analysis of studies published between December 2015 and April 2023.
- Inclusion of original studies evaluating predictors of CVEs within 30 days post-TAVR, adjusting for confounders.
- Multivariable meta-analyses using random-effects models, with results expressed as odds ratios (ORs) and 95% confidence intervals (CIs).
Main Results:
- Eleven predictors of early CVEs were identified from 74 studies.
- Nine patient-level predictors include CHA2DS2-VASc score ≥ 5, no prior heart failure, diabetes, isolated aortic stenosis, carotid artery stenosis, peripheral artery disease, advanced age, NYHA class ≥ III, and LV outflow tract calcification.
- Two procedure-level predictors are the absence of cerebral embolization protection and post-dilation.
Conclusions:
- Multiple patient and procedural factors are associated with early CVEs after TAVR.
- These identified factors can guide the creation of robust risk prediction models.
- Improved risk stratification will enhance clinical decision-making and patient management post-TAVR.
Background:
Early cerebrovascular events (CVEs) following transcatheter aortic valve replacement (TAVR) are severe complications, but effective methods for predicting and preventing these events have not been well established. A systematic review and meta-analysis were performed to identify significant predictors of early CVEs post-TAVR.
Methods:
MEDLINE/Embase databases were searched for articles published between December 2015 and April 2023. Original studies evaluating predictors of CVEs within 30 days post-TAVR after adjusting for confounders were included. Two investigators independently extracted data following the PRISMA statement. Meta-analyses of multivariable data were performed using DerSimonian and Laird random-effects models, with results expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Robustness was assessed via Harbord's test, nonparametric trim-and-fill analysis, leave-one-out sensitivity analysis, the QUIPS quality assessment tools, meta-regression, and subgroup analyses.
Results:
Among the 74 included studies, multivariate meta-analyses identified 11 predictors of early CVEs, including 9 patient-level predictors-a CHA2DS2-VASc ≥ 5, no prior heart failure, diabetes, isolated aortic stenosis, carotid artery stenosis, peripheral artery disease, advanced age, New York Heart Association class ≥ III, and significant left ventricular outflow tract calcification-and 2 procedure-level predictors: the absence of cerebral embolization protection and post-dilation. Additionally, 10 patient-level factors and 5 procedure-level factors were not associated with early CVEs, although significant heterogeneity was observed in most analyses.
Conclusions:
This study identified multiple patient-level and procedure-level factors associated or not associated with early CVEs after TAVR. These findings support the development of a comprehensive risk prediction model that can accommodate diverse patient populations and evolving procedural techniques, thereby enhancing clinical risk management strategies.
