Page 18 - Journal of Structural Heart Disease Volume 4, Issue 1

Original Scienti c Article
Journal of Structural Heart Disease, February 2018, Volume 4, Issue 1:9-16
DOI: https://doi.org/10.12945/j.jshd.2018.032.17
Received: July 23, 2017 Accepted: October 10, 2017 Published online: February 2018
Stroke Prevention With Carotid Compression in Patients Undergoing Transcatheter Aortic Valve Replacement: a Multi-Center Study
Anwar Tandar, MD1*, Kapildeo Luton, MD2, Abdulfattah Saidi, MD1, Brian R. Lindman, MD3,6, David Bull, MD4, Jason Glotzbach, MD4, Craig H. Selzman, MD4, Amit Patel, MD4,
Greg Stoddard, PhD5, Elizabeth Dranow, PhD1, Frederick G.P. Welt, MD1
1 Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA
2 Division of Cardiovascular Medicine, Banner Health Center, Phoenix, Arizona, USA
3 Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA 4 Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah, USA
5 Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA
6 Vanderbilt University Medical Center, Nashville, Tennessee, USA
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has revolutionized the management of se- vere aortic stenosis. However, TAVR is associated with several complications, including stroke. Carotid compression has been suggested as a simple maneu- ver to reduce embolic events during various cardiac procedures. Therefore, we examined the association between carotid compression and the incidence of transient ischemic attack (TIA) and stroke in patients undergoing TAVR.
Methods: This is a retrospective multicenter study of patients who underwent TAVR with and without carot- id compression. Primary outcomes were stroke or TIA 72 hours after the procedure and between 72 hours and 30-day follow-up. Data analysis was performed us- ing a propensity score technique with inverse probabil- ity weighting.
Results: A total of 306 TAVR patients were included in the study. Group I (n = 188) and II (n = 118) included pa- tients who did not or did undergo carotid compression during TAVR, respectively. The mean age was 82.5 ± 8.2 years in Group I and 78.5 ± 7.6 years in Group II. There was no signi cant di erence in combined stroke or TIA rate 72 hours after the procedure (1.1% vs. 1.9%, P = 0.50) or between 72 hours and 30-day follow-up (2.3%
vs 1.6%, P = 0.67).
Conclusions: Carotid compression during the TAVR pro- cedure is not associated with the incidence of compos- ite TIA or stroke after TAVR.
Copyright © 2018 Science International Corp.
Key Words
Transcatheter aortic valve replacement • Carotid compression • Stroke • Transient ischemic attack • Severe aortic stenosis
Introduction
Transcatheter aortic valve replacement (TAVR) has emerged in recent years as an attractive option for treating patients with symptomatic severe aortic stenosis (AS) who are deemed to be at intermedi- ate or high risk for surgical aortic valve replacement (SAVR) [1-3]. As TAVR continues to evolve, it requires improvements in device technology and implanta- tion techniques to minimize the rate of complications such as stroke. Stroke is a devastating complication that has been attributed to procedural factors [4]. The 30-day occurrence of all strokes in the PARTNER 1A tri-
* Corresponding Author:
Anwar Tandar, MD
Division of Cardiovascular Medicine
University of Utah
50 North Medical Drive, SOM, Room 4A100, Salt Lake City, UT 84132, USA
Tel. +1 801 585 5559; Fax: +1 801 581 7735; E-Mail: anwar.tandar@hsc.utah.edu
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2018 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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