827 Factors Associated With Stroke Post TAVI

Abstract

Transaortic Valve Implantation (TAVI) has emerged as an alternate treatment option in selected patients with critical aortic stenosis. Periprocedural stroke remains an uncommon but catastrophic complication following TAVI. We evaluated clinical variables and imaging characteristics of patients with stroke following TAVI, compared with matched (CHA2DS2-VASC) controls. A total of 45 patients, 15 with procedural related stroke (defined using the VARC 30-day protocol) and 30 matched controls were identified from our TAVI registry. Clinical variables and imaging characteristics including global longitudinal strain (GLS) of both left atrium (LA) and left ventricle (on intra-procedure echocardiogram) were assessed and compared between the two groups. Baseline characteristics (age, gender, CHA2DS2-VASC score, hypertension, diabetes, dyslipidaemia, presence of porcelain aorta, previous cardiovascular disease, previous cardiac surgery) and echocardiographic parameters were similar in the two groups except for higher BMI (25.2 vs 23.4 kg/m2, p=<0.003), higher AF prevalence (46% vs 36 %) and lower indexed LA volume (51.54±10.01 vs 59.96±22.82 ml/m2, p<0.001) in patients with postprocedure stroke. Baseline LA (15.72±7.67 % vs 11.56±10.5 %; p=NS) and left ventricular (14.54±6.06 % vs 12.74±6.09 %; p=NS) GLS were similar between the two groups. Pre-procedure AF and obesity are important risk factors for determining post TAVI 30-day stroke. Close consideration should be given to antithrombotic therapy management in obese AF patients listed for TAVI and immediately following the procedure.