TAVR slightly ups long-term stroke risk

The long-term risk of stroke seems to be higher in patients after transcatheter aortic valve replacement (TAVR), though some uncertainty remains whether such an effect is caused by predisposing risk factors or not, a recent study has found.

Researchers conducted a retrospective, nationwide follow-up of 4,205 patients who had undergone TAVR, followed for a median of 24.5 months (10,467 patient-years). The primary outcome was the development of stroke, as per two national registries, up to 8 years after TAVR. Participants’ background stroke risk was estimated based only on age and sex.

During follow-up, a total of 235 patients developed a stroke 30 days or more after TAVR. The resulting annual incidence rates of stroke ranged from 2.00 percent to 3.12 percent; standardized estimates, on the other hand, expected a range of 1.46 percent to 1.93 percent.

The 30-day mortality for stroke was 19.6 percent, which increased over time. By 1 year, the mortality rate had climbed to 44.1 percent, and further to 67.3 percent and 81.7 percent by 3 and 5 years, respectively.

Risk factors for the development of stroke included older age, male sex, a history of stroke, diabetes, and impaired estimated glomerular filtration rate. On the other hand, consciousness level at arrival was a strong predictor of mortality after stroke, such that those who were unconscious or had reduced consciousness were much more likely to die.

The present study found “an increased risk of stroke in this patient category, but it was unclear whether this was dependent on the TAVR valve per se or the higher frequency of pre-disposing risk factors in this cohort,” the researchers said.

“In any case, the risk increase is modest and should not affect decision-making in the treatment of aortic valve stenosis,” they added.