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June 18, 2019

Stroke After Transcatheter Aortic Valve Replacement: An Important but Underreported Outcome in Clinical Practice

Author Affiliations
  • 1Division of Vascular Neurology, University of Pennsylvania, Philadelphia
  • 2Division of Cardiac Surgery, University of Virginia, Charlottesville
JAMA. 2019;321(23):2287-2289. doi:10.1001/jama.2019.8613

Stroke after cardiovascular procedures has been associated with substantially increased morbidity, mortality, and cost.1 Aortic valve replacement is the most common intracardiac procedure performed in the United States and its use has been increasing over the past decade due to the aging of the population, improved survival from other conditions, and new technologies that allow for less invasive procedures. In 2010, the Placement of Aortic Transcatheter Valves (PARTNER) 1B randomized study2 involving patients at inoperable surgical risk reported that transcatheter aortic valve replacement (TAVR) improved survival compared with the best medical care. This study reported about a 7% risk of stroke, which was not surprising given the patient population and the likelihood of particulate embolization when expanding a new valve within the annulus of the stenosed and calcified native valve. Nevertheless, even with this stroke risk, there was a clear mortality benefit and quality of life was improved as well. After the PARTNER 1A high-risk cohort demonstrated similar or improved outcomes relative to open surgical aortic valve replacement (SAVR) in patients at high (but not inoperable) surgical risk, the US Food and Drug Administration (FDA) approved TAVR in 2011 and the procedure was rapidly adopted into clinical practice.3