BACKGROUND: Identifying transcatheter aortic valve replacement (TAVR) patients at high risk for cerebrovascular events (CVE) is of major clinical relevance. However, predictors have varied across studies. OBJECTIVES: The purpose of this study was to analyze the predictors of 30-day CVE post-TAVR. METHODS: A systematic review of studies that reported the incidence of CVE post-TAVR while providing raw data for predictors of interest was performed. Data on study, patient, and procedural characteristics were extracted. Crude risk ratios (RRs) and 95% confidence intervals for each predictor were calculated. RESULTS: Sixty-four studies involving 72,318 patients (2,385 patients with a CVE within 30 days post-TAVR) were analyzed. Incidence of CVE ranged from 1% to 11% (median 4%) without significant differences between single and multicenter studies, or according to CVE adjudication availability. The summary RRs indicated lower risk for men (RR: 0.82; p = 0.02) and higher risk for patients with chronic kidney disease (RR: 1.29; p = 0.03) and with new-onset atrial fibrillation post-TAVR (RR: 1.85; p = 0.005), and for procedures performed within the first half of center experience (RR: 1.55; p = 0.003). The use of balloon post-dilation tended to be associated with a higher risk of CVE (RR: 1.43; p = 0.07). Valve type (balloon-expandable vs. self-expandable, p = 0.26) and approach (transfemoral vs. nontransfemoral, p = 0.81) did not predict CVE. CONCLUSIONS: Female sex, chronic kidney disease, enrollment date, and new-onset atrial fibrillation were predictors of CVE post-TAVR. This study provides effect estimates to identify high-risk TAVR patients for early CVE, providing possible guidance for tailored preventive strategies.
BACKGROUND: Identifying transcatheter aortic valve replacement (TAVR) patients at high risk for cerebrovascular events (CVE) is of major clinical relevance. However, predictors have varied across studies. OBJECTIVES: The purpose of this study was to analyze the predictors of 30-day CVE post-TAVR. METHODS: A systematic review of studies that reported the incidence of CVE post-TAVR while providing raw data for predictors of interest was performed. Data on study, patient, and procedural characteristics were extracted. Crude risk ratios (RRs) and 95% confidence intervals for each predictor were calculated. RESULTS: Sixty-four studies involving 72,318 patients (2,385 patients with a CVE within 30 days post-TAVR) were analyzed. Incidence of CVE ranged from 1% to 11% (median 4%) without significant differences between single and multicenter studies, or according to CVE adjudication availability. The summary RRs indicated lower risk for men (RR: 0.82; p = 0.02) and higher risk for patients with chronic kidney disease (RR: 1.29; p = 0.03) and with new-onset atrial fibrillation post-TAVR (RR: 1.85; p = 0.005), and for procedures performed within the first half of center experience (RR: 1.55; p = 0.003). The use of balloon post-dilation tended to be associated with a higher risk of CVE (RR: 1.43; p = 0.07). Valve type (balloon-expandable vs. self-expandable, p = 0.26) and approach (transfemoral vs. nontransfemoral, p = 0.81) did not predict CVE. CONCLUSIONS: Female sex, chronic kidney disease, enrollment date, and new-onset atrial fibrillation were predictors of CVE post-TAVR. This study provides effect estimates to identify high-risk TAVR patients for early CVE, providing possible guidance for tailored preventive strategies.
Authors: Alexandra J Lansky; Steven R Messé; Adam M Brickman; Michael Dwyer; H Bart van der Worp; Ronald M Lazar; Cody G Pietras; Kevin J Abrams; Eugene McFadden; Nils H Petersen; Jeffrey Browndyke; Bernard Prendergast; Vivian G Ng; Donald E Cutlip; Samir Kapadia; Mitchell W Krucoff; Axel Linke; Claudia Scala Moy; Joachim Schofer; Gerrit-Anne van Es; Renu Virmani; Jeffrey Popma; Michael K Parides; Susheel Kodali; Michel Bilello; Robert Zivadinov; Joseph Akar; Karen L Furie; Daryl Gress; Szilard Voros; Jeffrey Moses; David Greer; John K Forrest; David Holmes; Arie P Kappetein; Michael Mack; Andreas Baumbach Journal: Eur Heart J Date: 2018-05-14 Impact factor: 29.983
Authors: Matteo Pagnesi; Luca Baldetti; Paolo Del Sole; Antonio Mangieri; Marco B Ancona; Damiano Regazzoli; Nicola Buzzatti; Francesco Giannini; Antonio Colombo; Azeem Latib Journal: Interv Cardiol Date: 2017-09
Authors: Hector Cubero-Gallego; Isaac Pascual; José Rozado; Ana Ayesta; Daniel Hernandez-Vaquero; Rocio Diaz; Alberto Alperi; Pablo Avanzas; Cesar Moris Journal: Ann Transl Med Date: 2019-10
Authors: Robert Michael Nechwatal; Kurt Bestehorn; Florian Leuschner; Andreas Hagendorff; Manju Guha; Axel Schlitt Journal: Herz Date: 2020-04-20 Impact factor: 1.443
Authors: Vinod H Thourani; Sean M O'Brien; John J Kelly; David J Cohen; Eric D Peterson; Michael J Mack; David M Shahian; Frederick L Grover; John D Carroll; J Matthew Brennan; Jessica Forcillo; Suzanne V Arnold; Sreekanth Vemulapalli; Susan Fitzgerald; David R Holmes; Joseph E Bavaria; Fred H Edwards Journal: Ann Thorac Surg Date: 2018-12-07 Impact factor: 4.330