Impact of Perioperative Stroke on Midterm Outcomes After Transcatheter Aortic Valve Replacement
| Autor: | Edgar Aranda-Michel, John Schindler, Andreas Habertheuer, Valentino Bianco, Dustin Kliner, Catalin Toma, Thomas G. Gleason, Alexa Kacin, Arman Kilic, Ibrahim Sultan |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty Time Factors Transcatheter aortic medicine.medical_treatment 030204 cardiovascular system & hematology Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Postoperative Complications Valve replacement Aortic valve replacement Modified Rankin Scale Risk Factors Internal medicine medicine Humans Stroke Perioperative stroke Aged Retrospective Studies Aged 80 and over business.industry Aortic Valve Stenosis medicine.disease Survival Rate Stenosis Treatment Outcome 030228 respiratory system Cardiology Surgery Female Cardiology and Cardiovascular Medicine Complication business |
| Zdroj: | The Annals of thoracic surgery. 110(4) |
| ISSN: | 1552-6259 |
| Popis: | Transcatheter aortic valve replacement (TAVR) has evolved as an alternative therapy to open aortic valve replacement in most patients with aortic stenosis. Stroke associated with TAVR can be a devastating complication in the short term; however, little is known regarding midterm outcomes.All patients undergoing TAVR at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania from 2011 to 2018 were included. Modified Rankin Scale values as a measurement of stroke-related disability were extracted for patients who had neurologic deficits.Neurologic events (NEs) developed in 51 (4.3%) of the 1193 patients during the study period (32 [2.7%] had disabling strokes; 19 [1.6%] had nondisabling strokes, including 5 [0.4%] transient ischemic attacks). Patients who had TAVR-related NEs were older (85.8 ± 4.2 years vs 81.5 ± 7.9 years; P.001) and predominantly female (68.6% vs 31.4%; P = .007), but they were comparable in terms of The Society of Thoracic Surgeons predicted mortality score and vascular access. Patients with NEs had increased short term and midterm mortality (15.7% vs 2.6%, 29.4% vs 13.9%, and 47.1% vs 35.7% at 30 days, 1 year, and 3 years, respectively). Severity of disability, determined by the modified Rankin Scale, was a risk factor for 30-day mortality (HR, 5.8; P = .003), 1-year mortality (HR, 2.1; P.001) and 3-year mortality (HR, 1.8; P.001). Predictors of TAVR NEs were older age (odds ratio [OR] per year of age, 1.11; P = .001), low body surface area (OR per mStroke increases short-term and midterm mortality after TAVR. Risk prediction for neurologic events in TAVR could aid the framework for patient selection and further improve outcomes. |
| Databáze: | OpenAIRE |
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