Transcatheter aortic valve replacement (TAVR) is more and more frequent in lower risk populations that had previously been treated with surgical valve replacement (SAVR). A small difference in neurological events could have significant consequences when it comes to deciding a course of action.

This study is a sub-analysis of the randomized study SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation).

Patients with severe symptomatic aortic stenosis and intermediate risk were randomized 1:1 to TAVR vs surgery. Neurological events rate and quality of life were analyzed at 30 days, 6 and 12 months after procedure (mean age was 79.8 ±6.2 years; n=1660).

Early post procedure stroke and encephalopathy (30 days) was higher with SAVR than with TAVR (5.4% vs. 3.3%; p=0.031; and 7.8% vs. 1.6%; p<0.001, respectively), though stroke rate caught up at 12 months (6.9% vs. 5.2%; p=0.136). Even though stroke rate was no different at one year, early stroke and encephalopathy had a negative impact, seeing that these patients showed higher mortality at 12 months in both groups.

Read also: TAVR in Low-Risk Patients with “Zero” Mortality and “Zero” Stroke.

Quality of life after stroke was worse in the SAVR branch, but this was true only at 30 days. Quality of life was similar at 6 and 12 months.

Conclusion

Early stroke rate was lower with TAVR than with SAVR in intermediate risk patients. After a stroke, quality of life improved faster after TAVR. Finally, at one year, stroke rate and quality of life levelled off.

Original title: Neurological Complications After Transcatheter Versus Surgical Aortic Valve Replacement in Intermediate-Risk Patients.

Reference: Andras P. Durko et al. J Am Coll Cardiol 2018;72:2109–19.

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