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J Am Coll Cardiol. 2018 Nov 13;72(20):2415-2426. doi: 10.1016/j.jacc.2018.08.2172.

Stroke After Surgical Versus Transfemoral Transcatheter Aortic Valve Replacement in the PARTNER Trial.

Author information

1
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. Electronic address: kapadis@ccf.org.
2
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
3
Department of Medicine, Division of Cardiology, Columbia University Medical Center/New York Presbyterian Hospital, New York, New York.
4
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
5
Department of Cardiology, Saint Luke's Health System, Kansas City, Missouri.
6
Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
7
Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC.
8
Division of Cardiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
9
Department of Cardiovascular Surgery, Baylor Scott & White Health, Plano, Texas.
10
Department of Cardiology, Baylor Scott & White Health, Plano, Texas.
11
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
12
Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
13
Department of Surgery, Columbia University Medical Center/New York Presbyterian Hospital, New York, New York.
14
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
15
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
16
Division of Cardiology, Columbia University Medical Center/New York Presbyterian Hospital, New York, New York.

Abstract

BACKGROUND:

Transfemoral-transcatheter aortic valve replacement (TF-TAVR) is increasingly used to treat aortic stenosis, but risk of post-procedure stroke is uncertain.

OBJECTIVES:

The purpose of this study was to assess stroke risk and its association with quality of life after surgical aortic valve replacement (SAVR) versus TF-TAVR.

METHODS:

The authors performed a propensity-matched study of 1,204 pairs of patients with severe aortic stenosis treated with SAVR versus TF-TAVR in the PARTNER (Placement of AoRTic TraNscathetER Valves) trials from April 2007 to October 2014. Outcomes were: 1) 30-day neurological events; 2) time-varying risk of neurological events early (≤7 days) and late (7 days to 48 months) post-procedure; and 3) association between stroke and quality of life 1 year post-procedure by the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score.

RESULTS:

Thirty-day stroke (5.1% vs. 3.7%; p = 0.09) was similar, but 30-day major stroke (3.9% vs. 2.2%; p = 0.018) was lower after TF-TAVR than SAVR. In both groups, risk of stroke peaked in the first post-procedure day, followed by a near-constant low-level risk to 48 months. Major stroke was associated with a decline in quality of life at 1 year in both SAVR (KCCQ score median [15th, 85th percentile]: 79 [53, 94] without major stroke vs. 64 [30, 94] with major stroke; p = 0.03) and TF-TAVR (78 [49, 96] without major stroke vs. 60 [8, 99] with major stroke; p = 0.04).

CONCLUSIONS:

Despite similar early-peaking (<1 day post-procedure) neurological risk profiles, SAVR is associated with a higher risk of early major stroke than TF-TAVR. Periprocedural strategies are needed to reduce stroke risk after aortic valve procedures. (Placement of AoRTic TraNscathetER Valve Trial [PARTNER]; NCT00530894).

KEYWORDS:

TAVR; aortic stenosis; cerebrovascular accident; quality of life; stroke

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