Lo Russo Gerardo V, Alarouri Hasan S, Al-Abcha Abdulah, Vogl Brennan, Mahayni Abdulah, Sularz Agata, Hatoum Hoda, Collins Jeremy, Crestanello Juan A, Alkhouli Mohamad
Department of Cardiovascular Medicine Mayo Clinic Rochester MN.
Department of Biomedical Engineering Michigan Technological University Houghton MI.
J Am Heart Assoc. 2024 Feb 20;13(4):e032963. doi: 10.1161/JAHA.123.032963. Epub 2024 Feb 13.
Acute ischemic stroke complicates 2% to 3% of transcatheter aortic valve replacements (TAVRs). This study aimed to identify the aortic anatomic correlates in patients after TAVR stroke.
This is a single-center, retrospective study of patients who underwent TAVR at the Mayo Clinic between 2012 and 2022. The aortic arch morphology was determined via a manual review of the pre-TAVR computed tomography images. An "a priori" approach was used to select the covariates for the following: (1) the logistic regression model assessing the association between a bovine arch and periprocedural stroke (defined as stroke within 7 days after TAVR); and (2) the Cox proportional hazards regression model assessing the association between a bovine arch and long-term stroke after TAVR. A total of 2775 patients were included (59.6% men; 97.8% White race; mean±SD age, 79.3±8.4 years), of whom 495 (17.8%) had a bovine arch morphology. Fifty-seven patients (1.7%) experienced a periprocedural stroke. The incidence of acute stroke was significantly higher among patients with a bovine arch compared with those with a nonbovine arch (3.6% versus 1.7%; =0.01). After adjustment, a bovine arch was independently associated with increased periprocedural strokes (adjusted odds ratio, 2.16 [95% CI, 1.22-3.83]). At a median follow-up of 2.7 years, the overall incidence of post-TAVR stroke was 6.0% and was significantly higher in patients with a bovine arch even after adjusting for potential confounders (10.5% versus 5.0%; adjusted hazard ratio, 2.11 [95% CI, 1.51-2.93]; <0.001).
A bovine arch anatomy is associated with a significantly higher risk of periprocedural and long-term stroke after TAVR.
急性缺血性卒中是经导管主动脉瓣置换术（TAVR）中2%至3%的患者会出现的并发症。本研究旨在确定TAVR术后发生卒中患者的主动脉解剖学相关因素。
这是一项对2012年至2022年间在梅奥诊所接受TAVR的患者进行的单中心回顾性研究。通过人工查看TAVR术前计算机断层扫描图像来确定主动脉弓形态。采用“先验”方法选择以下协变量：（1）评估牛型主动脉弓与围手术期卒中（定义为TAVR术后7天内发生的卒中）之间关联的逻辑回归模型；（2）评估牛型主动脉弓与TAVR术后长期卒中之间关联的Cox比例风险回归模型。共纳入2775例患者（59.6%为男性；97.8%为白种人；平均年龄±标准差为79.3±8.4岁），其中495例（17.8%）具有牛型主动脉弓形态。57例患者（1.7%）发生围手术期卒中。牛型主动脉弓患者的急性卒中发生率显著高于非牛型主动脉弓患者（3.6%对1.7%；P=0.01）。调整后，牛型主动脉弓与围手术期卒中增加独立相关（调整后的优势比为2.16[95%置信区间为1.22 - 3.83]）。在中位随访2.7年时，TAVR术后卒中的总体发生率为6.0%，即使在调整潜在混杂因素后，牛型主动脉弓患者的发生率仍显著更高（10.5%对5.0%；调整后的风险比为2.11[95%置信区间为1.51 - 2.93]；P<0.001）。
牛型主动脉弓解剖结构与TAVR术后围手术期和长期卒中风险显著升高相关。
