Predictors of Early Cerebrovascular Events in Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Auffret, Vincent; Regueiro, Ander; Trigo, María Del; Altisent, Omar Abdul‐Jawad; Campelo‐Parada, Francisco; Chiche, Olivier; Puri, Rishi; Rodés‐Cabau, Josep

doi:10.1016/j.jacc.2016.05.065

Cited by 166 publications

(83 citation statements)

References 98 publications

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“…Post‐hoc data from the PARTNER trial and other observational and meta‐analytical studies have shown new‐onset AF to be associated with greater risk for cerebrovascular events at 30 days. However, despite the anticipated adverse effects of AF, we did not observe statistically significant differences in 30‐day risk of outcomes compared with patients in sinus rhythm in this study.…”

Section: Discussioncontrasting

confidence: 80%

Impact of pre‐existing or new‐onset atrial fibrillation on 30‐day clinical outcomes following transcatheter aortic valve replacement: Results from the BRAVO 3 randomized trial

Hengstenberg

Chandrasekhar

Sartori

et al. 2017

Cathet Cardio Intervent

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Section: Discussioncontrasting

confidence: 80%

Impact of pre‐existing or new‐onset atrial fibrillation on 30‐day clinical outcomes following transcatheter aortic valve replacement: Results from the BRAVO 3 randomized trial

Hengstenberg

Chandrasekhar

Sartori

et al. 2017

Cathet Cardio Intervent

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“…In the US CoreValve studies, stroke occurred in 8.4% of patients at 1 year, and nearly half of the events occurred in the first 10 days after TAVR . In a meta‐analysis of >72,000 patients from 64 studies, 2,385 cerebrovascular events occurred within 30‐days . Across the study centers, the incidence ranged from 1% to 11%, with a median incidence of 4%.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter aortic valve replacement: The year in review 2016

Harjai

Grines

Paradis

et al. 2017

J Interven Cardiology

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Transcatheter aortic valve replacement (TAVR) continued to make major strides in 2016, simultaneously expanding its application to lower risk patients as well as more technically challenging subsets of patients with aortic stenosis (AS). The two major accomplishments this year were the establishment of TAVR as the preferred treatment strategy over surgical aortic valve replacement (SAVR) in intermediate risk patients, and initial signals that TAVR and SAVR may be clinically equivalent in low-risk populations. Meanwhile, there is continued expansion of TAVR to challenging clinical subsets (bicuspid aortic valve [BAV], patients with concomitant advanced coronary artery disease [CAD], and failed surgical bioprostheses), and encouraging initial experiences with newer transcatheter heart valve systems. This paper summarizes the major research studies published on TAVR in 2016.

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“…Defined according to VARC‐2 as a composite of all‐cause mortality, non‐fatal stroke, non‐fatal myocardial infarction, acute kidney injury, and pacemaker implantation within 30 days (±7) after TAVI …”

Section: Resultsmentioning

confidence: 99%

“…Post‐dilatation during the TAVI procedure may have a negative effect on prosthesis durability and increase the risk of cerebrovascular events . As such, its evasion is desirable.…”

Section: Discussionmentioning

confidence: 99%

Degree of valve calcification in patients undergoing transfemoral transcatheter aortic valve implantation with and without balloon aortic valvuloplasty: Findings from the multicenter EASE‐IT TF registry

Butter

Okamoto

Schymik

et al. 2019

Cathet Cardio Intervent

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Aims We aimed to assess whether the level of aortic root calcification is associated with BAV performance/omission during transcatheter aortic valve implantation (TAVI), and to explore related outcomes. Methods and results EASE‐IT TF was a prospective, observational, multicenter registry of patients undergoing TF‐TAVI with the Edwards SAPIEN 3, with or without BAV predilation. Valvular calcification was quantified from pre‐procedural multi‐slice computed tomography images and compared between BAV and no BAV patients. Data for 178 patients (55 BAV; 123 no BAV) were analyzed. There were no significant differences between groups in terms of regional/leaflet sector calcification volumes, maximum asymmetry between the different leaflet sectors, or total calcification scores. Overall, a greater‐than‐average leaflet calcification volume was independently predictive of ≥mild PVL (OR: 5.116; 95% CI: 1.042–38.35) and the need for post‐dilation (OR: 3.592; 95% CI: 1.173–12.14). The latter effect was abated in patients with BAV (OR: 1.837; 95% CI: 0.223–18.00) and intensified in those without BAV (OR: 5.575; 95% CI: 1.114–38.74). No other BAV‐dependent effects of calcification on outcomes were observed. Conclusions In the majority of transfemoral valve implantations, calcification does not appear to be the main driving factor in the decision to perform/omit BAV. Predilation may be valuable for reducing post‐dilation requirements in patients only with a greater degree of leaflet calcification.

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Predictors of Early Cerebrovascular Events in Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Abstract: 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.

Cited by 166 publications

References 98 publications

Impact of pre‐existing or new‐onset atrial fibrillation on 30‐day clinical outcomes following transcatheter aortic valve replacement: Results from the BRAVO 3 randomized trial

Impact of pre‐existing or new‐onset atrial fibrillation on 30‐day clinical outcomes following transcatheter aortic valve replacement: Results from the BRAVO 3 randomized trial

Transcatheter aortic valve replacement: The year in review 2016

Degree of valve calcification in patients undergoing transfemoral transcatheter aortic valve implantation with and without balloon aortic valvuloplasty: Findings from the multicenter EASE‐IT TF registry

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