Quebec Heart and Lung Institute, Laval University, Quebec City, Canada.
Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
JACC Cardiovasc Interv. 2024 Aug 12;17(15):1795-1807. doi: 10.1016/j.jcin.2024.05.040.
The Valve Academic Research Consortium (VARC)-3 definition for neurologic events after transcatheter aortic valve replacement (TAVR) lacks clinical validation.
This study sought to determine the incidence, predictors, and clinical impact of neurologic events following TAVR as defined by VARC-3 criteria.
This was a multicenter study including 2,924 patients with severe aortic stenosis undergoing TAVR. Based on Neurologic Academic Research Consortium (NeuroARC) classification, neurologic events were classified as NeuroARC type 1 (stroke), NeuroARC type 2 (covert central nervous system injury), and NeuroARC type 3 (transient ischemic attack and delirium). Baseline, procedural, and follow-up data were prospectively collected in a dedicated database.
After a median follow-up of 13 (7-37) months, neurologic events occurred in 471 patients (16.1%), NeuroARC type 1, 2, and 3 in 37.4%, 4.7%, and 58.0% of cases, respectively, and the majority (58.6%) were periprocedural. Advanced age, chronic kidney disease, atrial fibrillation, major vascular complications, and in-hospital bleeding determined an increased risk of periprocedural events (P < 0.03 for all). Neurologic events occurring during the periprocedural time frame were independently associated with a substantial increase in mortality at 1 year after the intervention (HR: 1.91; 95% CI: 1.23-2.97; P = 0.004). However, although NeuroARC type 1 was associated with an increased mortality risk (IRR: 3.38; 95% CI: 2.30-5.56; P < 0.001 and IRR: 21.7; 95% CI: 9.63-49.1; P < 0.001 for ischemic and hemorrhagic stroke, respectively), the occurrence of NeuroARC type 3 events had no impact on mortality.
Neurologic events after TAVR were associated with poorer short- and long-term survival. This correlation was related to the type of NeuroARC event defined by the VARC-3 criteria. Given the negative impact on clinical outcomes, every attempt should be made to reduce the risk of neurologic complications after TAVR.
经导管主动脉瓣置换术（TAVR）后神经事件的 Valve Academic Research Consortium（VARC）-3 定义缺乏临床验证。
本研究旨在根据 VARC-3 标准确定 TAVR 后神经事件的发生率、预测因素和临床影响。
这是一项多中心研究，纳入 2924 例严重主动脉瓣狭窄患者行 TAVR。根据神经学术研究联盟（NeuroARC）分类，神经事件分为 NeuroARC 1 型（中风）、NeuroARC 2 型（隐匿性中枢神经系统损伤）和 NeuroARC 3 型（短暂性脑缺血发作和谵妄）。前瞻性收集基线、手术和随访数据，存入专用数据库。
中位随访 13（7-37）个月后，471 例（16.1%）患者发生神经事件，分别有 37.4%、4.7%和 58.0%的病例发生 NeuroARC 1 型、2 型和 3 型，多数（58.6%）为围手术期事件。高龄、慢性肾脏病、心房颤动、大血管并发症和院内出血与围手术期事件风险增加相关（均 P<0.03）。围手术期发生的神经事件与介入后 1 年死亡率显著增加独立相关（HR：1.91；95%CI：1.23-2.97；P=0.004）。然而，尽管 NeuroARC 1 型与死亡率升高相关（IRR：3.38；95%CI：2.30-5.56；P<0.001 和 IRR：21.7；95%CI：9.63-49.1；P<0.001 分别为缺血性和出血性中风），NeuroARC 3 型事件的发生对死亡率无影响。
TAVR 后神经事件与短期和长期生存率降低相关。这种相关性与 VARC-3 标准定义的 NeuroARC 事件类型有关。鉴于对临床结局的负面影响，应尽一切努力降低 TAVR 后神经并发症的风险。
