Samir R Kapadia1, Chetan P Huded2, Susheel K Kodali3, Lars G Svensson4, E Murat Tuzcu2, Suzanne J Baron5, David J Cohen5, D Craig Miller6, Vinod H Thourani7, Howard C Herrmann8, Michael J Mack9, Molly Szerlip10, Raj R Makkar11, John G Webb12, Craig R Smith13, Jeevanantham Rajeswaran14, Eugene H Blackstone15, Martin B Leon16. 1. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. Electronic address: kapadis@ccf.org. 2. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. 3. Department of Medicine, Division of Cardiology, Columbia University Medical Center/New York Presbyterian Hospital, New York, New York. 4. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. 5. Department of Cardiology, Saint Luke's Health System, Kansas City, Missouri. 6. Department of Cardiothoracic Surgery, Stanford University, Stanford, California. 7. Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC. 8. Division of Cardiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania. 9. Department of Cardiovascular Surgery, Baylor Scott & White Health, Plano, Texas. 10. Department of Cardiology, Baylor Scott & White Health, Plano, Texas. 11. Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California. 12. Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 13. Department of Surgery, Columbia University Medical Center/New York Presbyterian Hospital, New York, New York. 14. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio. 15. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio. 16. Division of Cardiology, Columbia University Medical Center/New York Presbyterian Hospital, New York, New York.
Abstract
BACKGROUND:Transfemoral-transcatheter aortic valve replacement (TF-TAVR) is increasingly used to treat aortic stenosis, but risk of post-procedure stroke is uncertain. OBJECTIVES: The purpose of this study was to assess stroke risk and its association with quality of life after surgical aortic valve replacement (SAVR) versus TF-TAVR. METHODS: The authors performed a propensity-matched study of 1,204 pairs of patients with severe aortic stenosis treated with SAVR versus TF-TAVR in the PARTNER (Placement of AoRTic TraNscathetER Valves) trials from April 2007 to October 2014. Outcomes were: 1) 30-day neurological events; 2) time-varying risk of neurological events early (≤7 days) and late (7 days to 48 months) post-procedure; and 3) association between stroke and quality of life 1 year post-procedure by the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score. RESULTS: Thirty-day stroke (5.1% vs. 3.7%; p = 0.09) was similar, but 30-day major stroke (3.9% vs. 2.2%; p = 0.018) was lower after TF-TAVR than SAVR. In both groups, risk of stroke peaked in the first post-procedure day, followed by a near-constant low-level risk to 48 months. Major stroke was associated with a decline in quality of life at 1 year in both SAVR (KCCQ score median [15th, 85th percentile]: 79 [53, 94] without major stroke vs. 64 [30, 94] with major stroke; p = 0.03) and TF-TAVR (78 [49, 96] without major stroke vs. 60 [8, 99] with major stroke; p = 0.04). CONCLUSIONS: Despite similar early-peaking (<1 day post-procedure) neurological risk profiles, SAVR is associated with a higher risk of early major stroke than TF-TAVR. Periprocedural strategies are needed to reduce stroke risk after aortic valve procedures. (Placement of AoRTic TraNscathetER Valve Trial [PARTNER]; NCT00530894).
RCT Entities:
BACKGROUND: Transfemoral-transcatheter aortic valve replacement (TF-TAVR) is increasingly used to treat aortic stenosis, but risk of post-procedure stroke is uncertain. OBJECTIVES: The purpose of this study was to assess stroke risk and its association with quality of life after surgical aortic valve replacement (SAVR) versus TF-TAVR. METHODS: The authors performed a propensity-matched study of 1,204 pairs of patients with severe aortic stenosis treated with SAVR versus TF-TAVR in the PARTNER (Placement of AoRTic TraNscathetER Valves) trials from April 2007 to October 2014. Outcomes were: 1) 30-day neurological events; 2) time-varying risk of neurological events early (≤7 days) and late (7 days to 48 months) post-procedure; and 3) association between stroke and quality of life 1 year post-procedure by the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score. RESULTS: Thirty-day stroke (5.1% vs. 3.7%; p = 0.09) was similar, but 30-day major stroke (3.9% vs. 2.2%; p = 0.018) was lower after TF-TAVR than SAVR. In both groups, risk of stroke peaked in the first post-procedure day, followed by a near-constant low-level risk to 48 months. Major stroke was associated with a decline in quality of life at 1 year in both SAVR (KCCQ score median [15th, 85th percentile]: 79 [53, 94] without major stroke vs. 64 [30, 94] with major stroke; p = 0.03) and TF-TAVR (78 [49, 96] without major stroke vs. 60 [8, 99] with major stroke; p = 0.04). CONCLUSIONS: Despite similar early-peaking (<1 day post-procedure) neurological risk profiles, SAVR is associated with a higher risk of early major stroke than TF-TAVR. Periprocedural strategies are needed to reduce stroke risk after aortic valve procedures. (Placement of AoRTic TraNscathetER Valve Trial [PARTNER]; NCT00530894).
Authors: Michael J Reardon; Ted E Feldman; Christopher U Meduri; Raj R Makkar; Daniel O'Hair; Axel Linke; Dean J Kereiakes; Ron Waksman; Vasilis Babliaros; Robert C Stoler; Gregory J Mishkel; David G Rizik; Vijay S Iyer; Thomas G Gleason; Didier Tchétché; Joshua D Rovin; Thibault Lhermusier; Didier Carrié; Robert W Hodson; Dominic J Allocco; Ian T Meredith Journal: JAMA Cardiol Date: 2019-03-01 Impact factor: 14.676
Authors: Nicholas Aroney; Tiffany Patterson; Christopher Allen; Simon Redwood; Bernard Prendergast Journal: J Clin Med Date: 2021-04-20 Impact factor: 4.241