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.

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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.

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