Document Detail


Cerebrovascular accidents complicating transcatheter aortic valve implantation: frequency, timing and impact on outcomes.
MedLine Citation:
PMID:  22580250     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Aims: Cerebrovascular accidents (CVA) are considered among the most serious adverse events after transcatheter aortic valve implantation (TAVI). The objective of the present study was to evaluate the frequency and timing of CVA after TAVI and to investigate the impact on clinical outcomes within 30 days of the procedure. Methods and results: Between August 2007 and October 2011, 389 high-risk elderly patients with symptomatic severe aortic stenosis underwent TAVI via transfemoral, transapical or subclavian access. A total of 14 patients (3.6%) experienced at least one CVA within 30 days of follow-up and most events (74%) occurred within the first day of the procedure. Patients with CVA had an increased risk of all-cause (42.3% vs. 5.1%, ORadjusted 11.7, 95% CI 3.4-40.3, p<0.001) and cardiovascular mortality (38.4% vs. 4.6%, ORadjusted 10.5, 95% CI 2.9-37.8, p<0.001) compared to patients without CVA at 30 days of follow-up. Repeated device implantation attempts (ORadjusted 8.3, CI 2.1-33.3, p<0.003), chronic pulmonary disease (ORadjusted 4.7, CI 1.3-16.8, p=0.02) and body mass index <25 kg/m2 (ORadjusted 0.8, CI 0.7-0.9, p<0.01) emerged as independent predictors of periprocedural CVA. Conclusions: Cerebrovascular accidents among patients undergoing TAVI occur predominantly during the periprocedural period, are associated with multiple implantation attempts of the bioprosthesis and significantly impair prognosis.
Authors:
Stefan Stortecky; Stephan Windecker; Thomas Pilgrim; Dik Heg; Lutz Buellesfeld; Ahmed A Khattab; Christoph Huber; Steffen Gloekler; Fabian Nietlispach; Heinrich Mattle; Peter Jüni; Peter Wenaweser
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology     Volume:  8     ISSN:  1969-6213     ISO Abbreviation:  EuroIntervention     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-05-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101251040     Medline TA:  EuroIntervention     Country:  France    
Other Details:
Languages:  eng     Pagination:  62-70     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Swiss Cardiovascular Centre, Bern University Hospital, Bern, Switzerland.
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