Are the Rates of Stroke Similar in TAVR and Surgery?

Courtesy of Dr. Carlos Fava.

Stroke is one of the most undesirable complications we can face and, regarding transcatheter aortic valve replacement (TAVR), major studies presented have rates of stroke of about 4%. In others, rates have been slightly higher.

This meta-analysis included 5 randomized studies between 2011 and 2017: PARTNER, CoreVALVE, NOTION, PARTNER 2, and SURTAVI. Among included patients, 2755 underwent TAVR and 2659 underwent surgical aortic valve replacement. The rates of stroke were analyzed in both groups.

 

At 30 days, no differences were observed in the risk for stroke (relative risk [RR]: 0.85; 95% confidence interval [CI]: 0.59-1.22), major stroke (RR: 0.89; 95% CI: 0.53-1.51), or any kind of cerebrovascular event (RR: 0.94; 95% CI: 0.75-1.17) between strategies.


Read also: Angina Is as Subjective as Any Other Pain.


After a 1-year follow-up, no differences were observed either regarding the risk for stroke (RR: 0.92; 95% CI: 0.69-1.22), major stroke (RR: 0.92; 95% CI: 0.62-1.37), and any kind of cerebrovascular event (RR: 1.03; 95% CI: 0.79-1.33).

 

There was also an analysis between 30 days and 1 year, which showed no differences between TAVR and surgery.

 

Conclusion

This meta-analysis comparing TAVR and surgical aortic valve replacement showed comparable risk for stroke or any cerebrovascular event.

 

Editorial Comment

This meta-analysis shows similar risk for both strategies, but we must take into account that the studies analyzed are the first that began to show the benefit of TAVR with first-generation valves.

 

Second-generation valves and greater operator experience have proved to result in a lower risk of cerebrovascular events. Furthermore, there are increasingly more studies including cerebral protection systems in which the number of events is surely decreasing, thus ensuring higher TAVR effectiveness.

 

Courtesy of Dr. Carlos Fava.

 

Original title: Comparative Analysis of Cerebrovascular Events in Transcatheter and Surgical Aortic Valve Replacement: A Systematic Review and Meta-Analysis of Randomised Trials.

Reference: Divyanshu Mohananey, EuroIntervention 2018;14:69-77.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Coronary Artery Disease in Aortic Stenosis: CABG + SAVR vs. TAVR + PCI: Data from Spanish Centers

Multiple randomized studies have shown comparable or superior efficacy of transcatheter aortic valve replacement (TAVR) vs. coronary artery bypass graft (CABG).  However, many of...

TCT 2024 | TRISCEND II: A New Hope in Percutaneous Tricuspid Valve Replacement

Advanced tricuspid regurgitation (TR) is a debilitating disease associated with heart failure and increased mortality.  Edge-to-edge repair has been shown to improve both clinical condition...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....