Eschenbach Lena K, Erlebach Magdalena, Deutsch Marcus-André, Ruge Hendrik, Bleiziffer Sabine, Holzer Lisa, Krane Markus, Voss Stephanie, Lange Ruediger, Burri Melchior
Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität, München, Germany.
Department of Cardiovascular Surgery, German Heart Centre Munich, Insure (Institute for Translational Cardiac Surgery), Technische Universität München, Munich, Germany.
Catheter Cardiovasc Interv. 2022 May;99(6):1897-1905. doi: 10.1002/ccd.30143. Epub 2022 Mar 21.
We aimed to describe stroke and transient ischemic attacks (TIAs) after transcatheter aortic valve replacement (TAVR) and to identify associated risk factors.
Stroke/TIA after TAVR is a major complication.
A total of 1919 concomitant patients underwent TAVR in a single center from 2007 to 2017. Pre-, intra-, and postprocedural data were collected prospectively in a database and analyzed retrospectively. Stroke and TIA were documented according to the Valve Academic Research Consortium-II criteria. Logistic regression was used to determine risk factors for stroke after TAVR.
Mean age was 79.5 ± 6.8 years, mean logistic EuroScore was 17.6% ± 12.8%, and 51.8% (n = 994) of the patients were female. Stroke/TIA occurred in 76 patients (3.9%), 1.9% were disabling, and 1.6% nondisabling. The predominant type of stroke were territorial ischemic lesions (82.4%), with primary bleeding in 4.4% and border zone infarctions in 4.4%. Left-sided lesions were more common (45.6% left sided vs. 25% right sided) and 13.2% of the lesions were bilateral (4.4% no finding and 11.8% missing data). In multivariate logistic regression, prior stroke (odds ratio [OR] = 1.83, p = 0.046) and initial experience (first 300 TAVR implanted at our center) were identified as independent risk factors for stroke/TIA during the first 30 days (OR = 1.95, p = 0.045). Overall, the occurrence of stroke had a highly significant impact on a 30-day mortality (13.2% vs. 4.9% in patients without stroke (p = 0.005).
Stroke within the first 30 days after TAVR severely impairs 30-day survival. We identified prior stroke and initial experience as significant independent risk factors for the occurrence of stroke after TAVR.
我们旨在描述经导管主动脉瓣置换术（TAVR）后发生的卒中和短暂性脑缺血发作（TIA），并确定相关危险因素。
TAVR术后的卒中/TIA是一种主要并发症。
2007年至2017年，共有1919例合并症患者在单一中心接受了TAVR。术前、术中和术后数据前瞻性收集于一个数据库中，并进行回顾性分析。根据瓣膜学术研究联盟-II标准记录卒中和TIA。采用逻辑回归确定TAVR术后卒中的危险因素。
平均年龄为79.5±6.8岁，平均逻辑欧洲心脏手术风险评估系统（EuroScore）为17.6%±12.8%，51.8%（n = 994）的患者为女性。76例患者（3.9%）发生了卒中/TIA，其中1.9%为致残性，1.6%为非致残性。卒中的主要类型为局部缺血性病变（82.4%），原发性出血占4.4%，边缘带梗死占4.4%。左侧病变更为常见（左侧45.6% vs. 右侧25%），13.2%的病变为双侧性（4.4%未发现病变，11.8%数据缺失）。在多因素逻辑回归分析中，既往卒中（比值比[OR]=1.83，p = 0.046）和初始经验（本中心最初植入的300例TAVR）被确定为术后30天内发生卒中/TIA的独立危险因素（OR = 1.95，p = 0.045）。总体而言，卒中的发生对30天死亡率有高度显著影响（无卒中患者为4.9%，卒中患者为13.2%，p = 0.005）。
TAVR术后30天内的卒中严重影响30天生存率。我们确定既往卒中和初始经验是TAVR术后发生卒中的重要独立危险因素。
