Neurological complications after transcatheter versus surgical aortic valve replacement in intermediate-risk patients

Authors

Andras P Durko
Michael J Reardon
Neal S Kleiman
Jeffrey J Popma
Nicolas M Van Mieghem
Thomas G Gleason
Tanvir Bajwa, Advocate Aurora HealthFollow
Daniel O'Hair
David L Brown
William H Ryan
Yanping Chang
Sonia Diaz De Leon
Arie Pieter Kappetein

Recommended Citation

Durko AP, Reardon MJ, Kleiman NS, et al. Neurological Complications After Transcatheter Versus Surgical Aortic Valve Replacement in Intermediate-Risk Patients. J Am Coll Cardiol. 2018;72(18):2109-2119. doi: 10.1016/j.jacc.2018.07.093.

Affiliations

Departments of Cardiology and Cardiac Surgery, St. Luke's Medical Center

Abstract

BACKGROUND: Neurological events after aortic valve interventions are associated with increased mortality and morbidity. Transcatheter aortic valve replacement (TAVR) is increasingly offered for lower-risk patients with severe aortic stenosis, previously considered candidates for surgical aortic valve replacement (SAVR). Differences in post-procedural neurological events have important implications in treatment allocation.

OBJECTIVES: The authors sought to analyze the neurological events in the randomized SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial.

METHODS: Patients with severe, symptomatic aortic stenosis at intermediate surgical risk were randomized 1:1 to TAVR or SAVR. The rates of neurological events and quality of life were analyzed at 30 days, and 6 and 12 months post-procedure in a modified intention-to-treat population (mean age 79.8 ± 6.2 years; N = 1,660).

RESULTS: The rates of early (30-day) stroke and post-procedural encephalopathy were higher after SAVR versus TAVR (5.4% vs. 3.3%; p = 0.031; and 7.8% vs. 1.6%; p < 0.001, respectively). At 12 months, the rate of stroke was not different between SAVR and TAVR (6.9% vs. 5.2%; p = 0.136). Early stroke and early encephalopathy resulted in an elevated mortality at 12 months in both treatment groups. Quality of life after an early stroke was significantly lower in SAVR versus TAVR patients at 30 days and was similar at 6 and 12 months.

CONCLUSIONS: The early stroke rate was lower after TAVR than SAVR. In patients with early strokes, QOL improved earlier after TAVR. At 12-month follow-up, stroke rates and QOL were not different between TAVR and SAVR patients. (Surgical Replacement and Transcatheter Aortic Valve Implantation [SURTAVI]; NCT01586910).

Document Type

Article

PubMed ID

30360820