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Expert review

Risk of stroke after transcatheter aortic valve implantation (TAVI): a meta-analysis of 10,037 published patients

1. Cardioangiological Center Bethanien (CCB), Frankfurt, Germany; 2 Department of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany; 2. Duke Clinical Research Institute, Durham, NC, USA

Aims: Transcatheter aortic valve implantation (TAVI) represents a novel treatment option for inoperable or high surgical risk patients with severe symptomatic aortic valve disease. Recent randomised studies have raised major safety concerns because of increased stroke/transient ischemic attack (TIA) rates with TAVI compared to medical treatment and conventional aortic valve replacement. We aimed to review all currently published literature and estimate the incidence of periprocedural stroke and outcomes in patients undergoing TAVI.

Methods and results: Fifty-three studies including a total of 10,037 patients undergoing transfemoral, transapical or trans-subclavian TAVI for native aortic valve stenosis published between 01/2004 and 11/2011 were identified and included in a meta-analysis. Patients were 81.5±1.8-years-old and had a mean logistic EuroSCORE of 24.77±5.60%. Procedural stroke (<24 h) occurred in 1.5±1.4%. The overall 30-day stroke/TIA was 3.3±1.8%, with the majority being major strokes (2.9±1.8%). During the first year after TAVI, stroke/TIA increased up to 5.2±3.4%. Differences in stroke rates were associated with different approaches and valve prostheses used with lowest stroke rates after transapical TAVI (2.7±1.4%). Average 30-day mortality was more than 3.5-fold higher in patients with compared to those without stroke (25.5±21.9% vs. 6.9±4.2%).

Conclusions: TAVI was associated with average 30-day stroke/TIA rate of 3.3±1.8% (range 0-6%). Most of these strokes were major strokes and were associated with increased mortality within in the first 30 days.

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