title: Timing, predictive factors, and prognostic value of cerebrovascular events in a large cohort of patients undergoing transcatheter aortic valve implantation.
abstract: BACKGROUND
  The objective of this study was to evaluate the timing, predictive factors, and prognostic value of cerebrovascular events (CVEs) after transcatheter aortic valve implantation.
  
  
  RESULTS
  The study included 1061 consecutive patients who underwent transcatheter aortic valve implantation with a balloon-expandable (64%) or self-expandable (36%) valve. CVEs were classified as acute (≤24 hours), subacute (1-30 days), or late (>30 days). CVEs occurred in 54 patients (5.1%; stroke, 4.2%) within 30 days after transcatheter aortic valve implantation (acute in 54% of cases). The predictors of acute CVEs were balloon postdilation of the valve prosthesis (odds ratio, 2.46; 95% confidence interval,1.07-5.67) and valve dislodgment/embolization (odds ratio, 4.36; 95% CI, 1.21-15.69); new-onset atrial fibrillation (odds ratio, 2.76; 95% CI, 1.11-6.83) was a predictor of subacute CVEs. Late CVEs occurred in 35 patients (3.3%; stroke, 2.1%) at a median follow-up of 12 months (3-23 months). The predictors of late CVEs were chronic atrial fibrillation (2.84; 95% CI, 1.46-5.53), peripheral vascular disease (hazard ratio, 2.02; 95% CI, 1.02-3.97), and prior cerebrovascular disease (hazard ratio, 2.04; 95% CI, 1.01-4.15). Major stroke was associated with 30-day (odds ratio, 7.43; 95% CI, 2.45-22.53) and late (hazard ratio, 1.75; 95% CI, 1.01-3.04) mortality.
  
  
  CONCLUSIONS
  In a large cohort of patients undergoing transcatheter aortic valve implantation, the rates of acute and subacute CVEs were 2.7% and 2.4%, respectively. While balloon postdilation and valve dislodgment/embolization were the predictors of acute CVEs, new-onset atrial fibrillation determined a higher risk for subacute events. Late events were determined mainly by a history of chronic atrial fibrillation and peripheral and cerebrovascular disease. The occurrence of major stroke was associated with increased early and late mortality. These results provide important insights for the implementation of preventive measures for CVEs after transcatheter aortic valve implantation.
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada.
authors.forename: Luis
authors.initials: L
authors.lastname: Nombela-Franco
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.forename: Peter P
authors.initials: PP
authors.lastname: de Jaegere
authors.forename: Stefan
authors.initials: S
authors.lastname: Toggweiler
authors.forename: Rutger-Jan
authors.initials: RJ
authors.lastname: Nuis
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Dager
authors.forename: Ignacio J
authors.initials: IJ
authors.lastname: Amat-Santos
authors.forename: Anson
authors.initials: A
authors.lastname: Cheung
authors.forename: Jian
authors.initials: J
authors.lastname: Ye
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Binder
authors.forename: Robert M
authors.initials: RM
authors.lastname: van der Boon
authors.forename: Nicolas
authors.initials: N
authors.lastname: Van Mieghem
authors.forename: Luis M
authors.initials: LM
authors.lastname: Benitez
authors.forename: Sergio
authors.initials: S
authors.lastname: Pérez
authors.forename: Javier
authors.initials: J
authors.lastname: Lopez
authors.forename: José A
authors.initials: JA
authors.lastname: San Roman
authors.forename: Daniel
authors.initials: D
authors.lastname: Doyle
authors.forename: Robert
authors.initials: R
authors.lastname: Delarochellière
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.forename: Eric
authors.initials: E
authors.lastname: Dumont
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000209:etiology* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011379:Prognosis; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors