Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, 221 85, Lund, Sweden.
Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Lund University, Lund, Sweden.
Sci Rep. 2021 May 5;11(1):9593. doi: 10.1038/s41598-021-89217-0.
Transcatheter aortic valve replacement (TAVR) is a rapidly growing field. Short-term safety and efficacy of these procedures have been studied extensively. However, little is known about the safety of these devices over time. Stroke is one feared long-term complication, and an increased stroke rate could affect guidelines for treating both the aortic stenosis and choosing antithrombotic therapy after TAVR. The primary objective was to study the incidence of stroke up to 8 years after TAVR implantation, comparing it with the risk of stroke in the general population. Secondary objectives were to study risk factors for late stroke and to study outcomes after stroke. A nationwide, all-comers study of patients who underwent TAVR in Sweden 2008-2018 was performed. The study was based on data from three national registries: a TAVR registry, a stroke registry, and a diagnosis registry. The main outcome was stroke incidence 30-days or more after TAVR implantation and was compared to a standardized incidence. The annual risk for stroke varied between 2.0% and 3.1% as compared to 1.5% and 1.9% in an age- and sex-matched cohort. Risk factors for developing stroke were reduced renal function, diabetes, history of stroke, age, and male sex. The 1-year mortality after stroke was 44%. This study demonstrated an increased rate of stroke after TAVR, but the findings suggest that this can in part be attributed to the group's higher frequency of pre-disposing risk factors.
经导管主动脉瓣置换术（TAVR）是一个快速发展的领域。这些手术的短期安全性和疗效已经得到了广泛的研究。然而，关于这些设备随时间推移的安全性知之甚少。中风是一种令人担忧的长期并发症，如果中风发生率增加，可能会影响治疗主动脉瓣狭窄的指南以及 TAVR 后的抗血栓治疗选择。主要目的是研究 TAVR 植入后 8 年内的中风发生率，并与普通人群的中风风险进行比较。次要目的是研究晚期中风的危险因素，并研究中风后的结局。在瑞典进行了一项 2008-2018 年接受 TAVR 的患者的全国性、所有患者的研究。该研究基于来自三个国家登记处的数据：TAVR 登记处、中风登记处和诊断登记处。主要结局是 TAVR 植入后 30 天或以上的中风发生率，并与标准化发生率进行比较。中风的年风险在 2.0%至 3.1%之间，而年龄和性别匹配的队列中风风险为 1.5%至 1.9%。发生中风的危险因素是肾功能降低、糖尿病、中风史、年龄和男性。中风后 1 年的死亡率为 44%。这项研究表明 TAVR 后中风发生率增加，但研究结果表明，这在一定程度上可归因于该组中风的风险因素更频繁。
