Stroke remains a major complication and predictor of mortality following TAVR. A single center, randomized study of 100 patients has indicated that a cerebral protection device can reduce the frequency of ischaemic cerebral lesions as assessed by MRI. The use of the device was not associated with any adverse events.
Predictors of adverse cardiovascular (CV) events in patients undergoing TAVR are emerging as the technology becomes more widely adopted. A systematic review of 65 studies including 72,318 patients has identified female sex, renal impairment, new-onset atrial fibrillation, and whether the procedure was performed within the first half of the center’s experience as predictors of adverse CV events post TAVR.
The optimal preventive strategy for cerebral embolization following TAVR has remained elusive. The BRAVO-3MRI study, comparing a strategy of anticoagulation with bivalirudin or heparin, has indicated that cerebral embolization occurs in almost 2/3 of patients during TAVR and that bivalirudin was not superior to heparin as an anticoagulation agent.
Aortic regurgitation (AR), commonly assessed with echocardiography, post TAVR is associated with adverse outcomes. A study of 135 patients has indicated that higher regurgitant fraction as assessed by cardiovascular magnetic resonance (CMR) is associated with increased mortality and the combined endpoint of mortality and rehospitalization for heart failure.
The influence of concomitant mitral regurgitation (MR) in patients undergoing TAVR for severe aortic stenosis is unknown. A study of 589 patients has indicated that the presence of significant MR is associated with higher 30-day mortality. In the majority of patients however MR improved following successful TAVR.
Nathan Gray, CRTonline.org
Natalie Morrison, CRTonline.org
Sukhdeep Bhogal, CRTonline.org
Jason Wermers, CRTonline.org
Amer Aladin and Jason Wermers, CRTonline.org
Giorgio A. Medranda, CRTonline.org
Amer Aladin, CRTonline.org
Nicole Lou Reporter, MedPage Today/CRTonline.org
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