David Jochheim1, Magda Zadrozny2, Ingrid Ricard3, Tobias Mir Sadry2, Hans Theiss2, Moritz Baquet1, Florian Schwarz4, Axel Bauer1, Alexander Khandoga2, Sebastian Sadoni5, Maximilian Pichlmaier5, Joerg Hausleiter1, Christian Hagl6, Steffen Massberg1, Julinda Mehilli7. 1. Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany. 2. Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Germany. 3. Institute of Medical Informatics, Biometry and Epidemiology, Munich University Clinic, Ludwig-Maximilian University, Germany. 4. Department of Radiology, Munich University Clinic, Ludwig-Maximilian University, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany. 5. Department of Cardiac Surgery, Munich University Clinic, Ludwig-Maximilian University, Germany. 6. Department of Cardiac Surgery, Munich University Clinic, Ludwig-Maximilian University, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany. 7. Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany. Electronic address: Julinda.Mehilli@med.uni-muenchen.de.
Abstract
BACKGROUND: Clinical relevant cerebrovascular events (CVE) following transcatheter aortic valve implantation (TAVI) still remain a devastating complication associated with mortality and severe impairments. Therefore, identification of particularly modifiable predictors of this complication is clinically relevant and an important step for planning preventive strategies. METHODS: A total of 985 patients who underwent trans-femoral TAVI for aortic valve stenosis in our institution from February 2008 to January 2015 were considered. The influence of demographics, clinical and procedural data on the occurrence of CVE was assessed with a competing risk model with death as competing event. Clinical events were defined according to VARC-2 criteria. RESULTS: At a median follow-up of 838days, 95% CI 807-892, 59 patients experienced any CVE (5.9%) and the overall cumulative mortality rate was 46.1%. CVEs mainly occur later than 30days after TAVI (47.5%), 88.1% of them were of ischemic origin and 52.5% were disabling events. Independent predictors of CVEs were age (hazard ratio 1.05; 95% CI 1.01 to 1.09), history of CVE (hazard ratio 2.54; 95% CI 1.39 to 4.63) and use of balloon post-dilation (hazard ratio 1.85; 95% CI 1.08 to 3.18). CONCLUSION: In patients undergoing TAVI incidence of clinically relevant CVEs is frequent with half of the events occurring after the first 30days post-TAVI. Identification of balloon post-dilation as the only modifiable predictor of CVE risk at mid-term, urges its cautious performance after prosthesis implantation. CLINICALTRIALS. GOV IDENTIFIER: NCT02289339.
BACKGROUND: Clinical relevant cerebrovascular events (CVE) following transcatheter aortic valve implantation (TAVI) still remain a devastating complication associated with mortality and severe impairments. Therefore, identification of particularly modifiable predictors of this complication is clinically relevant and an important step for planning preventive strategies. METHODS: A total of 985 patients who underwent trans-femoral TAVI for aortic valve stenosis in our institution from February 2008 to January 2015 were considered. The influence of demographics, clinical and procedural data on the occurrence of CVE was assessed with a competing risk model with death as competing event. Clinical events were defined according to VARC-2 criteria. RESULTS: At a median follow-up of 838days, 95% CI 807-892, 59 patients experienced any CVE (5.9%) and the overall cumulative mortality rate was 46.1%. CVEs mainly occur later than 30days after TAVI (47.5%), 88.1% of them were of ischemic origin and 52.5% were disabling events. Independent predictors of CVEs were age (hazard ratio 1.05; 95% CI 1.01 to 1.09), history of CVE (hazard ratio 2.54; 95% CI 1.39 to 4.63) and use of balloon post-dilation (hazard ratio 1.85; 95% CI 1.08 to 3.18). CONCLUSION: In patients undergoing TAVI incidence of clinically relevant CVEs is frequent with half of the events occurring after the first 30days post-TAVI. Identification of balloon post-dilation as the only modifiable predictor of CVE risk at mid-term, urges its cautious performance after prosthesis implantation. CLINICALTRIALS. GOV IDENTIFIER: NCT02289339.
Authors: Julius Steffen; Nikolas Reißig; David Andreae; Markus Beckmann; Magda Haum; Julius Fischer; Hans Theiss; Daniel Braun; Martin Orban; Konstantinos Rizas; Sebastian Sadoni; Michael Näbauer; Sven Peterss; Jörg Hausleiter; Steffen Massberg; Simon Deseive Journal: Clin Res Cardiol Date: 2022-03-23 Impact factor: 5.460