Increased Stroke Risk Following Surgical vs Transfemoral Aortic Valve Replacement

Aortic valve replacement, heart surgery
Aortic valve replacement, heart surgery
Researchers evaluated stroke risk and its effect on quality of life after surgical aortic valve replacement vs transfemoral transcatheter aortic valve.

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).

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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.