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August 9, 2016

Improving Outcomes From Transcatheter Aortic Valve ImplantationProtecting the Brain From the Heart

Author Affiliations
  • 1Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia
  • 2Department of Cardiac Surgery, The Heart Hospital Baylor Plano, Plano, Texas
JAMA. 2016;316(6):587-588. doi:10.1001/jama.2016.10316

Perioperative stroke from cardiovascular procedures is associated with increased mortality and morbidity, prolonged hospitalization, and greater cost,1,2 and it is often the procedural complication most feared by patients. In recent years, there has been increased attention to these serious adverse events and an increased acceptance that they are occurring at a higher rate than prior studies suggested. Previous estimates of stroke incidence were often derived from clinical trials in which interventionalists, surgeons, and patients were carefully screened and narrowly selected, and postprocedural assessment of nervous system injury did not include clinical examinations by neurological specialists or sensitive imaging studies. In addition, quality improvement registries have generally used voluntary reporting of outcomes and retrospective chart abstraction, which likewise underreport the true incidence of neurological events. Studies in which neurology specialists have actively ascertained stroke complications after procedures are relatively rare, but have found much higher clinical event rates (approximately 5%-17%), and studies incorporating early magnetic resonance imaging (MRI) have found very high rates of clinically silent acute brain infarction (range, 25%-90%).35

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