In-Hospitalstroke After Transcatheter Aortic Valve Implantation: A Uk Observational Cohort Analysis

Objectives We sought to identify baseline demographics and procedural factors that might independently predict in-hospital stroke following transcatheter aortic valve implantation (TAVI). Background Stroke is a recognized, albeit infrequent, complication of TAVI. Established predictors of procedure-related in-hospital stroke; however, remain poorly defined. Methods We conducted an observational cohort analysis of the multicenter UK TAVI registry. The primary outcome measure was the incidence of in-hospital stroke. Results A total of 8,652 TAVI procedures were performed from 2007 to 2015. There were 205 in-hospital strokes reported by participating centers equivalent to an overall stroke incidence of 2.4%. Univariate analysis showed that the implantation of balloon-expandable valves caused significantly fewer strokes (balloon-expandable 96/4,613 [2.08%] vs. self-expandable 95/3,272 [2.90%];p= .020). After multivariable analysis, prior cerebrovascular disease (CVD) (odds ratio [OR] 1.51, 95% confidence interval [CI 1.05-2.17];p= .03), advanced age at time of operation (OR 1.02 [0.10-1.04];p= .05), bailout coronary stenting (OR 5.94 [2.03-17.39];p= .008), and earlier year of procedure (OR 0.93 [0.87-1.00];p= .04) were associated with an increased in-hospital stroke risk. There was a reduced stroke risk in those who had prior cardiac surgery (OR 0.62 [0.41-0.93];p= .01) and a first-generation balloon-expandable valve implanted (OR 0.72 [0.53-0.97];p= .03). In-hospital stroke significantly increased 30-day (OR 5.22 [3.49-7.81];p< .001) and 1-year mortality (OR 3.21 [2.15-4.78];p< .001). Conclusions In-hospital stroke after TAVI is associated with substantially increased early and late mortality. Factors independently associated with in-hospital stroke were previous CVD, advanced age, no prior cardiac surgery, and deployment of a predominantly first-generation self-expandable transcatheter heart valve.