title: Meta-Analysis of Perioperative Stroke and Mortality in Transcatheter Aortic Valve Implantation.
abstract: Transcatheter aortic valve implantation (TAVI) is a rapidly evolving safe method with decreasing incidence of perioperative stroke. There is a void in literature concerning the impact of stroke after TAVI in predicting 30-day stroke-related mortality. The primary aim of this meta-analysis was to determine whether perioperative stroke increases risk of stroke-related mortality after TAVI. Online databases, using relevant keywords, and additional related records were searched to retrieve articles involving TAVI and stroke after TAVI. Data were extracted from the finalized studies and analyzed to generate a summary odds ratio (OR) of stroke-related mortality after TAVI. The stroke rate and stroke-related mortality rate in the total patient population were 3.07% (893 of 29,043) and 12.27% (252 of 2,053), respectively. The all-cause mortality rate was 7.07% (2,053 of 29,043). Summary OR of stroke-related mortality after TAVI was estimated to be 6.45 (95% confidence interval 3.90 to 10.66, p <0.0001). Subgroup analyses were performed among age, approach, and valve type. Only 1 subgroup, transapical TAVI, was not significantly associated with stroke-related mortality (OR 1.97, 95% confidence interval, 0.43 to 7.43, p = 0.42). A metaregression was conducted among females, New York Heart Association class III/IV status, previous stroke, valve type, and implantation route. All failed to exhibit any significant associations with the OR. In conclusion, perioperative strokes after TAVI are associated with >6 times greater risk of 30-day stroke-related mortality. Transapical TAVI is not associated with increased stroke-related mortality in patients who suffer from perioperative stroke. Preventative measures need to be taken to alleviate the elevated rates of stroke after TAVI and subsequent direct mortality.
authors.affiliation: College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, Michigan.
authors.forename: Aditya
authors.initials: A
authors.lastname: Muralidharan
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Karthy
authors.initials: K
authors.lastname: Thiagarajan
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Raymond
authors.initials: R
authors.lastname: Van Ham
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Gleason
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Suresh
authors.initials: S
authors.lastname: Mulukutla
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: John T
authors.initials: JT
authors.lastname: Schindler
authors.affiliation: Saint Anthony Hospital, Oklahoma City, Oklahoma.
authors.forename: Vinodh
authors.initials: V
authors.lastname: Jeevanantham
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Electronic address: thirumalapd@upmc.edu.
authors.forename: Parthasarathy D
authors.initials: PD
authors.lastname: Thirumala
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002423:Cause of Death; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D009026:Mortality; D016017:Odds Ratio; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D012044:Regression Analysis; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality; D065467:Transcatheter Aortic Valve Replacement