Long-Term Risk of Stroke After Transcatheter Aortic Valve Replacement: Insights From the SwissTAVI Registry

Taishi Okuno; Bashir Alaour; Dik Heg; David Tueller; Thomas Pilgrim; Olivier Muller; Stephane Noble; Raban Jeger; Oliver Reuthebuch; Stefan Toggweiler; Enrico Ferrari; Christian Templin; Peter Wenaweser; Fabian Nietlispach; Maurizio Taramasso; Christoph Huber; Marco Roffi; Stephan Windecker; Stefan Stortecky

doi:10.1016/j.jcin.2023.10.021

Long-Term Risk of Stroke After Transcatheter Aortic Valve Replacement: Insights From the SwissTAVI Registry

JACC Cardiovasc Interv. 2023 Dec 25;16(24):2986-2996. doi: 10.1016/j.jcin.2023.10.021.

Authors

Taishi Okuno¹, Bashir Alaour¹, Dik Heg², David Tueller³, Thomas Pilgrim¹, Olivier Muller⁴, Stephane Noble⁵, Raban Jeger⁶, Oliver Reuthebuch⁷, Stefan Toggweiler⁸, Enrico Ferrari⁹, Christian Templin¹⁰, Peter Wenaweser¹¹, Fabian Nietlispach¹², Maurizio Taramasso¹³, Christoph Huber⁵, Marco Roffi⁵, Stephan Windecker¹, Stefan Stortecky¹⁴

Affiliations

¹ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
² CTU Bern, University of Bern, Bern, Switzerland.
³ Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland.
⁴ Department of Cardiology, Lausanne University Hospital - CHUV, Lausanne, Switzerland.
⁵ Division of Cardiology and Cardiovascular Surgery, University Hospital, Geneva, Switzerland.
⁶ Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland; University of Basel, Basel, Switzerland.
⁷ University of Basel, Basel, Switzerland; Department of Cardiovascular Surgery, Basel University Hospital, University of Basel, Basel, Switzerland.
⁸ Cantonal Hospital Lucerne, Lucerne, Switzerland.
⁹ Department of Cardiovascular Surgery, Cardiocentro Ticino Institute, Lugano, Switzerland.
¹⁰ Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland.
¹¹ Heart Clinic Hirslanden, Hirslanden Clinic Zurich, Zurich, Switzerland.
¹² Cardiovascular Center Zurich, Hirslanden Klinik Im Park, Zurich, Switzerland.
¹³ Heart Center Hirslanden, Hirslanden Clinic Zurich, Zurich, Switzerland.
¹⁴ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland. Electronic address: stefan.stortecky@insel.ch.

PMID: 38151313
DOI: 10.1016/j.jcin.2023.10.021

Abstract

Background: Stroke after transcatheter aortic valve replacement (TAVR) is associated with considerable morbidity and mortality. Predictors of stroke and the long-term risk after TAVR remain incompletely understood.

Objectives: The authors sought to investigate the short- and long-term incidence and predictors of stroke after TAVR in the SwissTAVI Registry.

Methods: Between February 2011 and June 2021, consecutive patients undergoing TAVR were included. Standardized stroke ratios (SSRs) were calculated to compare trends in stroke of TAVR patients with an age- and sex-matched general population in Switzerland derived from the 2019 Global Burden of Disease study.

Results: A total of 11,957 patients (81.8 ± 6.5 years of age, 48.0% female) were included. One-third of the patients (32.3%) had a history of atrial fibrillation, and 11.8% had a history of cerebrovascular accident. The cumulative 30-day incidence rate of stroke was 3.0%, with 69% of stroke events occurring within the first 48 hours after TAVR. The incidence of stroke was 4.3% at 1 year, and 7.8% at 5 years. Compared with an age- and sex-adjusted general population, the risk of stroke was significantly higher in the TAVR population during the first 2 years after TAVR: first year: SSR 7.26 (95% CI: 6.3-8.36) and 6.82 (95% CI: 5.97-7.79) for males and females, respectively; second year: SSR 1.98 (95% CI: 1.47-2.67) and 1.48 (95% CI: 1.09-2.02) for males and females, respectively; but returned to a comparable level to that observed in the matched population thereafter.

Conclusions: Compared with an age- and sex-matched population, TAVR patients experienced a higher risk of stroke for up to 2 years after the procedure, and a comparable risk thereafter. (SwissTAVI Registry; NCT01368250).

Keywords: aortic valve stenosis; cerebrovascular event; stroke; transcatheter aortic valve replacement.

MeSH terms

Aortic Valve / diagnostic imaging
Aortic Valve / surgery
Aortic Valve Stenosis* / diagnostic imaging
Aortic Valve Stenosis* / surgery
Female
Humans
Male
Middle Aged
Registries
Risk Factors
Stroke* / epidemiology
Stroke* / etiology
Transcatheter Aortic Valve Replacement*
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT01368250