title: Cerebrovascular events post-transcatheter aortic valve replacement in a large cohort of patients: a FRANCE-2 registry substudy.
abstract: OBJECTIVE
  The aim of this study was to analyze the incidence, impact, and predictors of cerebrovascular events (CVEs) in patients undergoing transcatheter aortic valve replacement (TAVR).
  
  
  BACKGROUND
  Several issues remain unresolved post-TAVR, including CVEs.
  
  
  METHODS
  The FRANCE-2 (French Aortic Nation CoreValve and Edwards-2) registry prospectively included all patients who underwent TAVR in France and Monaco from January 2010 to October 2011. A total of 3,191 patients were analyzed. Six-month follow-up data were obtained. Events were adjudicated according to Valve Academic Research Consortium (VARC)-1 definition.
  
  
  RESULTS
  Of the cohort, 3.98% experienced a CVE: 55% were major strokes, 14.5% minor strokes, and 30.5% transient ischemic attacks. The mean delay for CVE occurrence was 2 days (interquartile range: 0 to 7 days) with 48.5% of CVEs occurring within 2 days. There was no statistically significant difference in CVE rate with regard to the type of valve (p = 0.899) and the access route (p = 0.128). Patients with a CVE more frequently had new-onset paroxysmal atrial fibrillation (13.6% vs. 7.6%; p = 0.015). During follow-up, the unadjusted mortality rate was higher in patients with a CVE (26% vs. 16.5%; p = 0.002). By multivariate analysis, only advanced age (odds ratio: 1.05; 95% confidence interval: 1.02 to 1.08; p = 0.02) and having 2 valves implanted (odds ratio: 3.13; 95 confidence interval: 1.40 to 7.05; p = 0.006) were associated with a significant risk of CVEs.
  
  
  CONCLUSIONS
  CVEs occur frequently after TAVR and are associated with an increased mortality rate. No difference exists in the CVE rate when exploring the type of valve or the access route. Advanced age and multiple valves implanted during the same procedure are predictors of CVE.
authors.affiliation: Clinique Pasteur, Toulouse, France. Electronic address: d.tchetche@clinique-pasteur.com.
authors.forename: Didier
authors.initials: D
authors.lastname: Tchetche
authors.affiliation: Clinique Pasteur, Toulouse, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Farah
authors.affiliation: Clinique Pasteur, Toulouse, France.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Misuraca
authors.affiliation: Clinique Pasteur, Toulouse, France.
authors.forename: Adele
authors.initials: A
authors.lastname: Pierri
authors.affiliation: Clinique Pasteur, Toulouse, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Vahdat
authors.affiliation: Carrigaline Cork, Ireland.
authors.forename: Corinne
authors.initials: C
authors.lastname: Lereun
authors.affiliation: Centre Hospitalier Universitaire Rangueil, Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dumonteil
authors.affiliation: Centre Hospitalier Universitaire Lille, Lille, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Modine
authors.affiliation: Centre Hospitalier Universitaire Limoges, Limoges, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Laskar
authors.affiliation: Centre Hospitalier Universitaire Rouen, Rouen, France.
authors.forename: Helene
authors.initials: H
authors.lastname: Eltchaninoff
authors.affiliation: Centre Hospitalier Universitaire Bichat, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.affiliation: Centre Hospitalier Universitaire Bichat, Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.affiliation: Centre Hospitalier Universitaire Henri Mondor, Creteil, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Teiger
authors.affiliation: Centre Hospitalier Universitaire Henri Mondor, Creteil, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Chevreul
authors.affiliation: University of Lyon, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Lievre
authors.affiliation: Institut Jacques Cartier, Massy, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefevre
authors.affiliation: Institut Jacques Cartier, Massy, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Donzeau-Gouge
authors.affiliation: Centre Hospitalier Universitaire Brest, Brest, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
authors.affiliation: Clinique Pasteur, Toulouse, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Fajadet
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D001281:Atrial Fibrillation / Q000453:epidemiology; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D005260:Female; D005602:France / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008984:Monaco / Q000453:epidemiology; D015999:Multivariate Analysis; D016017:Odds Ratio; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
keywords: cerebrovascular events; predictive factors; transcatheter aortic valve replacement