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Comparison of periprocedural and mid-term stroke rates and outcomes between surgical aortic valve replacement and transcatheter aortic valve replacement patients.
- Source :
-
The Journal of cardiovascular surgery [J Cardiovasc Surg (Torino)] 2017 Aug; Vol. 58 (4), pp. 591-597. Date of Electronic Publication: 2016 Apr 14. - Publication Year :
- 2017
-
Abstract
- Background: We compared stroke occurrence and outcomes between Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR), both periprocedural and at follow-up.<br />Methods: From March 2012 to December 2014, 391 consecutive patients underwent TAVR (N.=290) or isolated SAVR (N.=101), concomitantly. Patients' data were prospectively collected.<br />Results: TAVR patients had more comorbidities. One (0.34%) TIA and 9 (3.11%) strokes occurred in-hospital following TAVR, but no cerebrovascular event occurred after SAVR (P=0.11). One stroke (0.99%) and one TIA (0.99%) were detected in SAVR group within 30 days. Among TAVR patients, one (0.75%) stroke at 6 months, 2 (1.9%) strokes and 2 (1.9%) TIAs at 12 months were diagnosed. Kaplan-Meier analysis revealed that 96% and 99% 12-month CVA free survival following TAVR and SAVR, respectively (P=0.67). Preoperative mean trans-aortic valve systolic pressure gradient higher than 40 mmHg remained as risk factor for stroke in TAVR patients only, OR: 4.48 (CI: 1.2-16.54, P=0.02). One intraoperative death, and 5 (4 with CVA) in-hospital deaths occurred after TAVR; whereas only one patient died in SAVR group (P=0.49). Thirty-day mortality was 3.8% (11/290) for TAVR and 0.99% (1/101) for SAVR patients. SAVR patients' survival was 99% at 6 months, 97.9% at 12, and 96.4% at 24 months, whereas survival in TAVR was 97.5% at 6, 92% at 12, and 73.6% at 24 months (HR: 8.43 (CI: 2.47-28.73), P<0.001).<br />Conclusions: Even with significant differences in patients' baseline characteristics; in-hospital and mid-term stroke rates are not significantly higher following TAVR than SAVR. Although periprocedural stroke is not uncommon in TAVR, mid-term stroke rate is low.
- Subjects :
- Aged
Aged, 80 and over
Aortic Valve physiopathology
Aortic Valve Stenosis diagnosis
Aortic Valve Stenosis mortality
Aortic Valve Stenosis physiopathology
Cardiac Catheterization instrumentation
Cardiac Catheterization mortality
Disease-Free Survival
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation instrumentation
Heart Valve Prosthesis Implantation mortality
Hospital Mortality
Humans
Kaplan-Meier Estimate
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Process Assessment, Health Care
Propensity Score
Proportional Hazards Models
Prospective Studies
Risk Factors
Stroke diagnosis
Stroke mortality
Time Factors
Treatment Outcome
Aortic Valve surgery
Aortic Valve Stenosis therapy
Cardiac Catheterization adverse effects
Heart Valve Prosthesis Implantation adverse effects
Stroke etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1827-191X
- Volume :
- 58
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- The Journal of cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 27078127
- Full Text :
- https://doi.org/10.23736/S0021-9509.16.09390-3