Increased Stroke Risk Following Surgical vs Transfemoral Aortic Valve Replacement

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Investigators conducted a propensity-matched study of 1204 pairs of patients with severe aortic stenosis treated with SAVR vs TF-TAVR in the Placement of AoRTic TraNscathetER Valves trials.
Investigators conducted a propensity-matched study of 1204 pairs of patients with severe aortic stenosis treated with SAVR vs TF-TAVR in the Placement of AoRTic TraNscathetER Valves trials.

A higher risk for early major stroke after the use of surgical aortic valve replacement (SAVR) vs transfemoral transcatheter aortic valve replacement (TF-TAVR) in patients at similar risk has been reported in a propensity-matched study, with the occurrence of major stroke associated with a significantly lower quality of life (QoL) at 1 year postprocedure. Results of the study were published in the Journal of the American College of Cardiology.

The investigators conducted their study in a total of 1204 pairs of patients with severe aortic stenosis who were treated with SAVR vs TF-TAVR in the Placement of AoRTic TraNscathetER Valves (PARTNER) trials between April 2007 and October 2014. The following outcomes were assessed: 30-day neurologic events, time-varying risk for occurring early (ie, ≤7 days) and late (ie, 7 days to 48 months) postprocedure, and association between stroke and QoL 1 year postprocedure according to the overall summary score of the Kansas City Cardiomyopathy Questionnaire.

No statistically significant differences were observed between the SAVR and TF-TAVR groups with respect to occurrence of 30-day stroke (5.1% vs 3.7%, respectively; P =.09) or 30-day neurologic events (5.4% vs 4.2%, respectively; P =.18). The occurrence of 30-day major stroke, however, was significantly higher after SAVR than after TF-TAVR (3.9% vs 2.2%, respectively; P =.018).

The probability of occurrence of time-related stroke at 7 days, 30 days, 1 year, and 4 years was 4.5%, 5.1%, 6.4%, and 10%, respectively, after SAVR and 3.4%, 3.7%, 5.7%, and 9.3%, respectively, after TF-TAVR. Taking into consideration the competing risk for death before stroke, the mortality-adjusted likelihood of experiencing a stroke was 4.6%, 5.2%, 6.4%, and 9.1% after SAVR and 3.4%, 3.7%, 5.5%, and 8.3% after TF-TAVR at 7 days, 30 days, 1 year, and 4 years, respectively.

Furthermore, major stroke was associated with a decline in QoL at 1 year in both the SAVR arm (Kansas City Cardiomyopathy Questionnaire score median [15th, 85th percentile]: 79 [53-94] without major stroke compared with 64 [30-94] with major stroke; P =.03) and the TF-TAVR arm (78 [49-96] without major stroke vs 60 [8-99] with major stroke; P =.04).

The investigators concluded that the development of periprocedural strategies is warranted to reduce patients' risk for stroke during both SAVR and TF-TAVR. This should offer the potential to markedly improve the safety of aortic valve procedures in the near future.

Reference

Kapadia SR, Huded CP, Kodali SK, et al; PARTNER Trial Investigators. Stroke after surgical versus transfemoral transcatheter aortic valve replacement in the PARTNER trial. J Am Coll Cardiol. 2018;72(20):2415-2426.

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