Exploring the Difference in Post-procedural Stroke Rates Between Patients with Aortic Stenosis Who Undergo Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement

Abstract

Transcatheter aortic valve replacement (TAVR) is a newer alternative to surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis. Clinical trials have investigated TAVR's safety and effectiveness. Cerebral embolization is a common complication leading to stroke after TAVR and SAVR; different cerebral protection methods have been studied to prevent this.This paper evaluates the rate of post-procedural stroke rates between TAVR and SAVR and investigates the effect of cerebral protective methods on the stroke risk post-TAVR.Publications on TAVR and SAVR were found using specific criteria on PubMed. The Placement of Aortic Transcatheter Valves 1 (PARTNER 1) and PARTNER 2, the Nordic Aortic Valve Intervention (NOTION), and Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI) trials compared the incidence of complications between TAVR and SAVR. The Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCED), CoreValve (Medtronic, Minneapolis, MN), Neurologic Complications of Unprotected Transcatheter Aortic Valve Implantation (Neuro-TAVI), Repositionable Percutaneous Replacement of Stenotic Aortic Valve Through Implantation of LotusTM Valve System (Boston Scientific, Marlborough, MA) - Randomized Clinical Evaluation (REPRISE II), and The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STC/ACC TVT) registry studies further explored the risk of stroke in TAVR. The Effect of Bivalirudin on Aortic Valve Intervention Outcomes (BRAVO)-3 MRI, a prospective randomized evaluation of the TriGuardTM HDH (Keystone Heart, Tampa, FL) Embolic Deflection Device During Transcatheter Aortic Valve Replacement (DEFLECT III), Claret Embolic Protection and Transcatheter Aortic Valve Implantation (CLEAN-TAVI), and Cerebral Protection in Transcatheter Aortic Valve Replacement (SENTINEL) trials investigated cerebral protection methods post-TAVR for stroke prevention.In the PARTNER 1 trial, the stroke rate was greater in the TAVR group than in the SAVR group at one year (8.3% vs. 4.3%, P=0.04); the PARTNER 2 trial showed a lower risk of stroke at two years (6.2% and 6.4%, respectively). The NOTION and SURTAVI trials showed no significant difference in stroke rate between TAVR and SAVR at one year (13.1% vs 16.3%, respectively; p = 0.43). An increase in stroke rate after TAVR was found in the ADVANCED trial (5.6% at 31 days - two years) and CoreValve trial (4.3% in the late phase). The Neuro-TAVI trial showed ischemia after TAVR in 20% of patients at discharge. In the STC/ACC TVT Registry, the rate of post-procedure disabling stroke was 1.7% at 30 days. Finally, the BRAVO-3 MRI study showed no advantages between bivalirudin or unfractionated heparin in preventing cerebral lesion formation (65.5% vs 58.1%, respectively; p = 0.55). The DEFLECT III, CLEAN-TAVI, and SENTINEL trials assessed the safety and efficacy of transcatheter cerebral embolic protection devices (CEPDs); their results ranged from 50% improvement (CLEAN-...

Bilateral Simultaneous Middle Cerebral Artery Mechanical Thrombectomy for Periprocedural Transcatheter Aortic Valve Implantation Stroke: A Case Report

“…Transcatheter aortic valve replacement is the standard treatment of choice at present for aortic stenosis. 4 One of the major complications includes stroke. The rate of incidence of stroke is much higher in surgically treated aortic stenosis than TAVI.…”

Transcatheter aortic valve implantation in low-risk patients: A case of rational over exuberance. The time is not now

“…22 Recent comparisons find similar, or slightly lower stroke risk with TAVI versus SAVR (Supplementary Tables 2 and 4). Cerebral embolic protection devices will improve TAVI neurological outcomes, 23 albeit at increased expense, and recent trials demonstrate both minimal effect, and 50% reduction in cerebral lesions. 23…”

“…Cerebral embolic protection devices will improve TAVI neurological outcomes, 23 albeit at increased expense, and recent trials demonstrate both minimal effect, and 50% reduction in cerebral lesions. 23…”

Anemia and risk of periprocedural cerebral injury detected by diffusion-weighted magnetic resonance imaging in patients undergoing transcatheter aortic valve replacement

“…[3,4] Despite the amelioration in technique and technology of TAVR, questions remain related to the safety and effi cacy of this procedure, especially regarding to the complications that follow TAVR. [5][6][7][8] Silent ischemic cerebral infarction is one of the major concerns that have been associated with TAVR. Previous studies reported as high as 58%-91% of new silent ischemic stroke detected by diffusion-weighted magnetic resonance imaging (DW-MRI) occurred following TAVR.…”