NEUROLOGICAL events following transcatheter aortic valve replacement (TAVR), as defined by the Valve Academic Research Consortium (VARC)-3 criteria, are associated with worse survival outcomes, according to recent research.
A multicentre study aimed to validate the VARC-3 definitions of neurologic events and assess their incidence, predictors, and impact on clinical outcomes in patients undergoing TAVR. A total of 2,924 patients with severe aortic stenosis were included. Neurologic events were categorised using the Neurologic Academic Research Consortium (NeuroARC) classification into three types: stroke (NeuroARC type 1), covert central nervous system injury (type 2), and transient ischemic attack or delirium (type 3).
After a median follow-up of 13 months, neurologic events were observed in 16.1% of patients. Of these, 37.4% were NeuroARC type 1 events, 4.7% were type 2, and 58% were type 3. The majority (58.6%) of events occurred in the periprocedural period. Risk factors for periprocedural events included advanced age, chronic kidney disease, atrial fibrillation, major vascular complications, and in-hospital bleeding (p< 0.03 for all). Neurologic events, particularly periprocedural ones, were significantly associated with higher mortality one-year post-TAVR (hazard ratio: 1.91; p= 0.004). Notably, NeuroARC type 1 events, especially ischemic and haemorrhagic strokes, were linked to the highest mortality risk, while type 3 events did not impact survival.
In conclusion, neurologic events following TAVR, especially strokes, lead to poorer survival outcomes, emphasising the importance of reducing their incidence in clinical practice. Identifying high-risk patients and implementing preventive strategies could mitigate the adverse effects of these neurologic complications, improving both short- and long-term patient outcomes. Further research should focus on optimising procedural techniques and post-operative care to minimize these risks.
Katrina Thornber, EMJ
Reference
Avvedimento M et al. Incidence, predictors, and prognostic impact of neurologic events after TAVR according to VARC-3 Criteria. JACC Cardiovasc Interv. 2024;17(15):1795-807.
