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Predictors of early stroke after transcatheter aortic valve replacement
Session:
SESSÃO DE POSTERS 51 - DIAGNÓSTICO E PROGNÓSTICO NA INTERVENÇÃO VALVULAR AÓRTICA PERCUTÂNEA
Speaker:
Rafael Viana
Congress:
CPC 2025
Topic:
G. Aortic Disease, Peripheral Vascular Disease, Stroke
Theme:
24. Stroke
Subtheme:
24.7 Heart and Brain Interaction
Session Type:
Cartazes
FP Number:
---
Authors:
Rafael Viana; Antonio Almeida; Marta Paralta de Figueiredo; Rita Louro; Orlando Luquengo; Miguel Carias; Bruno Piçarra; Diogo Bras; David Neves; Angela Bento; Renato Fernandes; Lino Patrício
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction: Despite a decrease in the rates of stroke when compared to initial transcatheter aortic valve replacement (TAVI) experience, stroke remains a severe complication following TAVI and is associated with increased morbimortality. Therefore, identifying patients at a higher risk could potentially impact outcomes.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Purpose: Our aim is to identify possible predictors of in-hospital stroke after TAVI for severe aortic stenosis (AS).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: We retrospectively analyzed patients submitted to TAVI in our institution between 2021 and 2024. We documented demographic characteristics, risk scores, echocardiographic data pre-TAVI, CT-scan data and TAVI-procedure details. We then performed univariate analysis to establish the relationship between variables and incidence of stroke and multivariate analysis to identify independent predictors.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: We analyzed a population of 300 patients and documented an in-hospital stroke rate of 2.7% (n=8). The population was 46.3% male (n=139), with a mean age of 83±5 years. Additionally, 86% were hypertensive, 71.3% had dyslipidemia, 34.7% were diabetic, 10.7% were smokers, 21.1% had a history of coronary artery disease, 21.7% had a history of atrial fibrillation (AF), and 17% had an STS score greater than 8. Regarding demographic characteristics and details of the TAVI procedure, including pre- and post-dilatation, there were no significant differences between groups. However, patients who experienced early stroke were more frequently classified with an STS score > 8 (50% vs. 16%, p=0.012), had a higher prevalence of paradoxical low-flow low-gradient (pLFLG) aortic stenosis (25% vs. 6%, p=0.032), and higher aortic root angles (52º vs. 48º, p=0.049). After multivariate analysis, all variables maintained their significance (p=0.027, p=0.020, p=0.036, respectively). </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion: In our population, patients submitted to TAVI with higher STS scores (>8), pLFLG aortic stenosis, and larger aortic root angles are at significantly increased risk for early in-hospital stroke. This could have clinical decision-making impact regarding the use of cerebral protection devices during the TAVI procedure. However, larger and more comprehensive studies are necessary.</span></span></p>
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