Strokes after TAVR remain a problem: Key insights from new registry data
In-hospital strokes still occur in 2.5% of patients who undergo transcatheter aortic valve replacement (TAVR), according to new registry data published in Structural Heart.[1] Researchers are hoping to learn as much as possible about which patients may face the highest risk if selected for treatment.
The new analysis focused on more than 5,000 patients who underwent TAVR in Japan from 2022 to 2024. All patients received one of the widely used contemporary transcatheter heart valves—the Sapien 3 Ultra Resilia from Edwards Lifesciences, Evolut FX from Medtronic, or Navitor from Abbott—and all data came from the multicenter OCEAN-TAVI registry.
“Ischemic stroke remains one of the most devastating adverse events following TAVR; it is associated with increased mortality, prolonged hospitalization, and impaired long-term functional outcomes,” wrote first author Yusuke Watanabe, MD, a researcher with Teikyo University School of Medicine in Tokyo, and colleagues. “In response to this persistent risk, cerebral embolic protection (CEP) devices have been developed to reduce embolic load during valve deployment. However, large randomized trials … have shown no significant reduction in overall stroke rates with routine CEP use. These findings have shifted the clinical conversation toward identifying high-risk subgroups who may derive selective benefit from CEP.”
Watanabe et al. found that the in-hospital stroke rate for TAVR patients receiving a contemporary transcatheter heart valve was 2.5%. Survival after one year occurred in 73% of patients who experienced an in-hospital stroke and 90.3% of patients who did not experience an in-hospital stroke.
After an inverse probability of treatment weighting adjustment, the in-hospital stroke rates for each valve type were 1.7% for the Sapien 3 Ultra Resilia, 4.5% for the Evolut FX and 2.4% for the Navitor. In addition, the group found that self-expanding valves, patients with reduced renal function, nontransfemoral access and a history of stroke were all independently associated with a heightened risk of in-hospital stroke.
The researchers believe their findings point to the value of taking a “risk-tailored approach” to stroke prevention after TAVR.
“Despite advances in valve design and technique, the overall stroke rate has plateaued,” the authors wrote. “Our study highlights specific predictors, such as the use of self-expanding valves, prior stroke, renal dysfunction, and nonfemoral access, that define a higher-risk subset. These findings may inform future risk stratification strategies.”
Click here to read the full analysis.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.