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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.
J Cardiovasc Surg (Torino). 2017 Aug; 58(4):591-597.JC

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.

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.

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).

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.

Authors+Show Affiliations

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA.Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA.Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA.Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA.Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA. North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA - charles.klodell@surgery.ufl.edu.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27078127

Citation

Aalaei-Andabili, Seyed Hossein, et al. "Comparison of Periprocedural and Mid-term Stroke Rates and Outcomes Between Surgical Aortic Valve Replacement and Transcatheter Aortic Valve Replacement Patients." The Journal of Cardiovascular Surgery, vol. 58, no. 4, 2017, pp. 591-597.
Aalaei-Andabili SH, Anderson RD, Petersen JW, et al. Comparison of periprocedural and mid-term stroke rates and outcomes between surgical aortic valve replacement and transcatheter aortic valve replacement patients. J Cardiovasc Surg (Torino). 2017;58(4):591-597.
Aalaei-Andabili, S. H., Anderson, R. D., Petersen, J. W., Beaver, T. M., Bavry, A. A., & Klodell, C. T. (2017). Comparison of periprocedural and mid-term stroke rates and outcomes between surgical aortic valve replacement and transcatheter aortic valve replacement patients. The Journal of Cardiovascular Surgery, 58(4), 591-597. https://doi.org/10.23736/S0021-9509.16.09390-3
Aalaei-Andabili SH, et al. Comparison of Periprocedural and Mid-term Stroke Rates and Outcomes Between Surgical Aortic Valve Replacement and Transcatheter Aortic Valve Replacement Patients. J Cardiovasc Surg (Torino). 2017;58(4):591-597. PubMed PMID: 27078127.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of periprocedural and mid-term stroke rates and outcomes between surgical aortic valve replacement and transcatheter aortic valve replacement patients. AU - Aalaei-Andabili,Seyed Hossein, AU - Anderson,R David, AU - Petersen,John W, AU - Beaver,Thomas M, AU - Bavry,Anthony A, AU - Klodell,Charles T, Y1 - 2016/04/14/ PY - 2016/4/15/pubmed PY - 2017/6/20/medline PY - 2016/4/15/entrez SP - 591 EP - 597 JF - The Journal of cardiovascular surgery JO - J Cardiovasc Surg (Torino) VL - 58 IS - 4 N2 - 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. 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. 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). 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. SN - 1827-191X UR - https://www.unboundmedicine.com/medline/citation/27078127/Comparison_of_periprocedural_and_mid_term_stroke_rates_and_outcomes_between_surgical_aortic_valve_replacement_and_transcatheter_aortic_valve_replacement_patients_ L2 - http://www.minervamedica.it/index2.t?show=R37Y2017N04A0591 DB - PRIME DP - Unbound Medicine ER -