Impact of cerebral protection on observed versus predicted in-hospital stroke in a high stroke risk TAVR cohort.

Humans Male Female Aged Transcatheter Aortic Valve Replacement / adverse effects Risk Factors Risk Assessment Aged, 80 and over Stroke / prevention & control Treatment Outcome Embolic Protection Devices Aortic Valve Stenosis / surgery Time Factors Intracranial Embolism / prevention & control Retrospective Studies Decision Support Techniques Predictive Value of Tests
Aortic stenosis Cerebral Embolic Protection Stroke Transcatheter aortic valve replacement

Journal

BMC cardiovascular disorders
ISSN: 1471-2261
Titre abrégé: BMC Cardiovasc Disord
Pays: England
ID NLM: 100968539

Informations de publication

Date de publication:
13 Aug 2024
Historique:
received: 14 04 2024
accepted: 06 08 2024
medline: 13 8 2024
pubmed: 13 8 2024
entrez: 12 8 2024
Statut: epublish

Résumé

Despite impressive improvements in the safety profile of Transcatheter aortic valve replacement (TAVR), the risk for peri-procedural stroke after TAVR has not declined substantially. In an effort to reduce periprocedural stroke, cerebral embolic protection (CEP) devices have been utilized but have yet to demonstrate benefit in all-comers. There is a paucity of data supporting the utilization of CEP in TAVR patients with an anticipated high risk for peri-procedural stroke. The Transcatheter Aortic Valve Replacement In-Hospital Stroke (TASK) score is a clinical risk tool for predicting the in-hospital stroke risk of patients undergoing transfemoral TAVR. This score was used to identify high-risk patients and calculate the expected in-hospital stroke risk. This was a single-centre cohort study in all consecutive TAVR patients who had placement of CEP. The observed versus expected ratio for peri-procedural stroke was calculated. To obtain 95% credible intervals, we used 1000 bootstrapped samples of the original cohort sample size without replacement and recalculated the TASK predicted scores. The study included 103 patients. The median age was 83 (IQR 78,89). 63 were male (61.1%) and 45 (43.69%) had a history of previous Stroke or TIA. Two patients had an in-hospital stroke after TAVR (1.94%). The expected risk of in-hospital stroke based on the TASK score was 3.39% (95% CI 3.07-3.73). The observed versus expected ratio was 0.57 (95% CI 0.52-0.64). In this single-center study, we found that in patients undergoing TAVR with high stroke risk, CEP reduced the in-hospital stroke risk by 43% when compared with the risk-score predicted rate. N/A.

Sections du résumé

BACKGROUND BACKGROUND
Despite impressive improvements in the safety profile of Transcatheter aortic valve replacement (TAVR), the risk for peri-procedural stroke after TAVR has not declined substantially. In an effort to reduce periprocedural stroke, cerebral embolic protection (CEP) devices have been utilized but have yet to demonstrate benefit in all-comers. There is a paucity of data supporting the utilization of CEP in TAVR patients with an anticipated high risk for peri-procedural stroke.
METHODS METHODS
The Transcatheter Aortic Valve Replacement In-Hospital Stroke (TASK) score is a clinical risk tool for predicting the in-hospital stroke risk of patients undergoing transfemoral TAVR. This score was used to identify high-risk patients and calculate the expected in-hospital stroke risk. This was a single-centre cohort study in all consecutive TAVR patients who had placement of CEP. The observed versus expected ratio for peri-procedural stroke was calculated. To obtain 95% credible intervals, we used 1000 bootstrapped samples of the original cohort sample size without replacement and recalculated the TASK predicted scores.
RESULTS RESULTS
The study included 103 patients. The median age was 83 (IQR 78,89). 63 were male (61.1%) and 45 (43.69%) had a history of previous Stroke or TIA. Two patients had an in-hospital stroke after TAVR (1.94%). The expected risk of in-hospital stroke based on the TASK score was 3.39% (95% CI 3.07-3.73). The observed versus expected ratio was 0.57 (95% CI 0.52-0.64).
CONCLUSION CONCLUSIONS
In this single-center study, we found that in patients undergoing TAVR with high stroke risk, CEP reduced the in-hospital stroke risk by 43% when compared with the risk-score predicted rate.
CLINICAL TRIAL NUMBER BACKGROUND
N/A.

Identifiants

DOI: 10.1186/s12872-024-04097-2 PMID: 39135174
pubmed: 39135174
doi: 10.1186/s12872-024-04097-2
pii: 10.1186/s12872-024-04097-2
doi:

Types de publication

Journal Article Comparative Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

422

Informations de copyright

© 2024. The Author(s).

Références

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Auteurs

Erez Marcusohn (E)

Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.

Ragavie Manoragavan (R)

Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.

Stephen Fremes (S)

Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
Division of Cardiac Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.

Christopher Tarola (C)

Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
Division of Cardiac Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.

Janarthanan Sathananthan (J)

Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada.
Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada.
St. Paul's Hospital, Centre for Heart Valve Innovation, University of British Columbia, Vancouver, BC, Canada.

Israel M Barabash (IM)

Interventional Cardiology Unit, Leviev Heart and Vascular Center, Chaim Sheba Medical Center, Ramat Gan, Israel.
Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.

Ady Orbach (A)

Cardiology Department, Edith Wolfson Medical Center, Holon, Israel.

Ayaaz K Sachedina (AK)

Foothills Medical Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada.

Sam Radhakrishnan (S)

Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.

Harindra C Wijeysundera (HC)

Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. harindra.wijeysundera@sunnybrook.ca.
Temerty Faculty of Medicine, University of Toronto, Toronto, Canada. harindra.wijeysundera@sunnybrook.ca.
ICES, Toronto, Canada. harindra.wijeysundera@sunnybrook.ca.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. harindra.wijeysundera@sunnybrook.ca.

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questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Impact of cerebral protection on observed...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie thoracique › Procédures de chirurgie cardiaque › Implantation de valve prothétique cardiaque › Remplacement valvulaire aortique par cathéter › Impact of cerebral protection on observed...
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