Neurological Events Following Transcatheter Aortic Valve Replacement and Their Predictors
| Autor: | Neal S. Kleiman, Brijeshwar J. Maini, Michael J. Reardon, John Conte, Stanley Katz, Vivek Rajagopal, James Kauten, Alan Hartman, Raymond McKay, Robert Hagberg, Jian Huang, Jeffrey Popma, David Adams, Niv Ad, Vicken Aharonian, William D. Anderson, Robert Applegate, Amar Bafi, Tanvir Bajwa, Mamdouh Bakhos, Stephen Ball, Sanjay Batra, Nirat Beohar, William Brachinsky, Derek Brinster, John Brown, John Byrne, Timothy Byrne, Alfred Casale, Michael Caskey, Atul Chawla, Howard Cohen, Joseph Coselli, Marco Costa, John Cheatham, Stanley J. Chetcuti, Juan Crestanello, Thomas Davis, G. Michael Deeb, Jose Diez, Harold Dauerman, John Elefteriades, Peter Fail, Edgar Feinberg, Gregory Fontana, John L. Forrest, Aubrey Galloway, John Giacomini, Thomas G. Gleason, Vincent Guadiani, J. Kevin Harrison, Robert Hebeler, David Heimansohn, John Heiser, Louis Heller, Scott Henry, James Hermiller, David Hockmuth, G. Chad Hughes, James Joye, Ali Kafi, Biswajit Kar, Kamal Khabbaz, Robert Kipperman, Chad Kliger, Neal Kon, Joseph Lamelas, Joon Sup Lee, Ferdinand Leya, Juan Carlos Londono, Steven Macheers, Abeel Mangi, Eduardo de Marchena, Alan Markowitz, Ray Matthews, William Merhi, Mubashir Mumtaz, Daniel O’Hair, George Petrossian, Thomas Pfeffer, Bryan Raybuck, Jon Resar, Mark Robbins, Robert Robbins, Newell Robinson, Michael Ring, Tomas Salerno, Theodore Schreiber, Joseph Schmoker, Samin Sharma, Lee Siwek, Kimberly Skelding, James Slater, Vaughn Starnes, Robert Stoler, Valavanur Subramanian, Peter Tadros, Craig Thompson, Ron Waksman, Daniel Watson, Steven Yakubov, David Zhao, George L. Zorn |
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| Rok vydání: | 2016 |
| Předmět: |
Balloon Valvuloplasty
Male Aortic valve medicine.medical_specialty Time Factors medicine.medical_treatment Kaplan-Meier Estimate 030204 cardiovascular system & hematology Risk Assessment Severity of Illness Index Transcatheter Aortic Valve Replacement Angina 03 medical and health sciences Coronary artery bypass surgery 0302 clinical medicine Valve replacement Risk Factors Internal medicine medicine Humans 030212 general & internal medicine Stroke Aged Proportional Hazards Models Aged 80 and over Bioprosthesis Body surface area Clinical Trials as Topic business.industry Incidence Hazard ratio Cardiac Pacing Artificial Calcinosis Aortic Valve Stenosis medicine.disease Surgery Treatment Outcome medicine.anatomical_structure Intracranial Embolism Aortic Valve Heart Valve Prosthesis Aortic valve stenosis Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation: Cardiovascular Interventions. 9 |
| ISSN: | 1941-7632 1941-7640 |
| DOI: | 10.1161/circinterventions.115.003551 |
| Popis: | Background— The risk for stroke after transcatheter aortic valve replacement (TAVR) is an important concern. Identification of predictors for stroke is likely to be a critical factor aiding patient selection and management as TAVR use becomes widespread. Methods and Results— Patients enrolled in the CoreValve US Extreme Risk and High Risk Pivotal Trials or Continued Access Study treated with the self-expanding CoreValve bioprosthesis were included in this analysis. The 1-year stroke rate after TAVR was 8.4%. Analysis of the stroke hazard rate identified an early phase (0–10 days; 4.1% of strokes) and a late phase (11–365 days; 4.3% of strokes). Baseline predictors of early stroke included National Institutes of Health stroke scale score >0, prior stroke, prior transient ischemic attack, peripheral vascular disease, absence of prior coronary artery bypass surgery, angina, low body mass index (2 ), and falls within the past 6 months. Significant procedural predictors were total time in the catheterization laboratory or operating room, delivery catheter in the body time, rapid pacing used during valvuloplasty, and repositioning of the prosthesis. Predictors of stroke between 11 and 365 days were small body surface area, severe aortic calcification, and falls within the past 6 months. There were no significant imaging predictors of early or late stroke. Conclusions— Predictors of early stroke after TAVR included clinical and procedural factors; predictors of later stroke were limited to patient but not anatomic characteristics. These findings indicate that further refinement of imaging to identify anatomic factors predisposing to embolization may help improve stroke prediction in patients undergoing TAVR. Clinical Trial Registrations— URL: http://www.clinicaltrials.gov . Unique identifiers: NCT01240902, NCT01531374. |
| Databáze: | OpenAIRE |
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