Transcatheter Aortic Valve Replacement without Predilation Yields Similar Rates of Short-term Stroke
Tuesday, May 21, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
Giorgio A Medranda, M.D.
,
NYU Winthrop Hospital, Brooklyn, NY
Kunal Brahmbhatt, M.D.
,
NYU Winthrop Hospital, Mineola, NY
Anjili Srivastava, D.O.
,
NYU Winthrop Hospital, Mineola, NY
Rafael J Hernandez, BS
,
NYU Winthrop Hospital, Mineola, NY
Khaled Salhab, M.D.
,
NYU Winthrop Hospital, Mineola, NY
Richard K Schwartz, D.O.
,
NYU Winthrop Hospital, Mineola, NY
Stephen J Green, M.D.
,
NYU Winthrop Hospital, Mineola, NY
Background:
Stroke is one of the most feared complications following transcatheter aortic valve replacement (TAVR). It is associated with severe disability and high mortality. Balloon aortic valvuloplasty (BAV) prior to TAVR has traditionally been recommended prior to valve deployment. The relationship between pre-TAVR BAV and stroke has been described using the initial generations of TAVR valves. The purpose of this study was to investigate the association between pre-TAVR BAV and short-term stroke following TAVR using contemporary valves.
Methods:
This was a retrospective, observational study from 2016-2018 in which we screened 730 patients who underwent TAVR using second and third generation valves at our institution. Excluded were 70 patients who have valve in valve TAVR. The primary outcomes of interest were inpatient and 30-day stroke. The secondary outcomes of interest were procedure time, contrast volume, fluoroscopy time and procedural success. Statistical analyses of outcomes were performed using Fisher's exact test and two-sample t-test.
Results:
Included were 660 patients of which 88 patients had pre-TAVR BAV (cohort 1) and 572 patients did not have pre-TAVR BAV (cohort 2). Inpatient stroke did not differ between cohort 1 (1.1%) and cohort 2 (0.5%) (p=0.4366). Stroke at 30 days did not differ between cohort 1 (1.1%) and cohort 2 (0.5%) (p=0.4366). Procedure time and contrast volume did not differ between cohort 1 (91.8 minutes, 114.6 milliliters) and cohort 2 (83.2 minutes, 103.9 milliliters) (p=0.1041, p=0.0785, respectively). Fluoroscopy time did improve when comparing cohort 1 (12.3 minutes) to cohort 2 (9.6 minutes) (p=0.0088). Procedural success was similar between cohort 1 (98.9%) and cohort 2 (98.8%) (p=1).
Conclusions:
Stroke remains one of the most devastating complications following TAVR. Pre-TAVR BAV has been recommended prior to TAVR. The safety and feasibility of omitting pre-TAVR BAV has been investigated using older generation TAVR valves in the literature. Our study suggests that direct TAVR, using contemporary valves, can yield acceptable short-term outcomes and procedural success with reduction in fluoroscopy time.
