UPmémoires

English

Objective: Transcatheter Aortic Valve Implantation ( is recommended for patients at high risk for open aortic valve surgery. Postoperative stroke is a known complication of TAVI, but predictors of early stroke have not been specifically reviewed. The objective of this study was to estimate the incidence and the predictors of stroke in the first 30 days post TAVI. Methods: Patient records were extracted from a prospective database including all TAVI procedures. The analysis focused on 506 consecutive patients who underwent TAVI between January 1, 2017, and June 30, 2019, at Poitiers University Hospital. Preoperative, intraoperative and postoperative variables were investigated by univariate and multivariate analyses to find those predicting the occurre nce of stroke in the first 30 days following TAVI. The impact of cardiac and vascular complications on mortality and stroke were also investigated.

Results: The incidence of stroke during TAVI or in the 30 days following TAVI was 4.9%, [ 95% 3.3 7.2]. Af ter multivariate analysis, the predictors of stroke related to TAVI were a previous stroke or TIA (Odds ratio [ 3.2; 95% CI: 1.2 8.5; p 0.02); catheterization through the arteries to the head compared to the femoral route ( 9.6; 95% CI: 3.2 to 28 p 0.001) and introduction of a single antithrombotic agent against two or three after TAVI ( 5.5; CI 95%: 2.1 to 14.4; p 0.001).

The overall 30 day mortality rate was 3.9%, [ CI 2.5 6.0] including two ruptures of the aortic ring which were l ethal. Patients with a previous bypass surgery or coronary artery stenting had a significantly higher risk of death ( 2.9; 95% CI: 1.1 7.6; p=0.01), as patients with a stroke Post TAVI ( 6.3; 95% CI: 1.9 20.0; p<0.001). Other main complications follo wing TAVI were cardiac conduction disorders ( including atrioventricular block ( and hemorrhage or thrombosis related to arterial catheterization ( None of these complications was associated with the risk of stroke or death.

Conclusions: In this retrospective study, occurrence of a previous stroke was associated with a 3 fold increase of post TAVI stroke. A supra aortic route for catheterization, and a single antithrombotic treatment after TAVI were associated respectively with a 9 fold and a 5 fold increase of post TAVI stroke and should be avoided wherever possible.