Page 22 - Journal of Structural Heart Disease Volume 4, Issue 1

13
Original Scienti c Article
Table 3. Covariate balance across control and treatment groups after weighting on the propensity score.
Age 80.96 80.29 8.5 Female 0.45 0.45 0.0 Hypertension 0.94 0.93 3.8
in Group I and 78.5 ± 7.6 years in Group II. There were more males in both Group I and II (54.3% and 63.6%, respectively). Procedural characteristics are shown in Table 2. The average length of stay was 5.8 ± 4.6 days in Group I and 5.1 ± 3.8 days in Group II.
Unadjusted Results
Before propensity adjustment, post-procedure CVAs were observed in 1.6% of patients in Group I and 2.5% of patients in Group II, with a risk ratio (RR) of 1.59 (95% CI, 0.33–7.78, P = 0.57). Late CVA rates were 2.7% in Group I and 2.5% in Group II, with a RR of 0.96 (CI 95%, 0.23–3.94, P = 0.95).
Adjusted Results
After propensity adjustment, post-procedure CVAs were observed in 1.1% of patients in Group I and 1.9% of patients in Group II, with a RR of 1.77 (95% CI, 0.34–9.39, P = 0.50). Late CVA rates were 2.3% for Group I and 1.6% for Group II, with a RR of 0.72 (95% CI, 0.16–3.18, P = 0.67).
Subgroup Analysis
We evaluated the association between speci c clinical characteristics and carotid compression with regard to disabling stroke and TIA risk after the pro- cedure. Due to the small number of events, subgroup analysis could be completed only for the following baseline characteristics: carotid stenosis, atrial bril- lation, previous stroke or TIA, and gender. There were no changes in risk of disabling stroke at discharge among analyzed subgroups (Figure 1).
Discussion
We found that patients who received or did not re- ceive carotid compression during TAVR exhibited no signi cant di erence in risk of disabling stroke after the procedure. While the data do not show any bene- t in the use of carotid compression, they also do not show evidence of harm associated with carotid com- pression. It is possible that carotid compression may limit microemboli. The clinical signi cance, of any, of microemboli detected by transcranial Doppler that do not manifest in overt TIA or stroke is still unknown [24].
Covariate
No Carotid Compression (standard- ized mean)
Carotid Compression (standardized mean)
Standardized Di erence (%)
Atrial brillation 0.44 0.48 - pre-procedure
COPD 0.31 0.29
-9.6
5.3
Baseline EF 0.05 0.03 11.4 (<30%)
BMI 28.74 28.19 7.9
Chronic Kidney 0.54 0.53 Disease
Prior aortic 0.14 0.08 valve procedure
2.5
19.9
Anticoagulants 0.40 0.46 -13.3 pre-procedure
Procedure time 131.27 133.77 -4.0 Annulus size 22.80 22.65 5.8
Atrial brillation 0.02 0.00 – new, post-pro-
cedure
10.0
Data Analysis. Adjusted risk ratios for post-proce- dure and late stroke were estimated with 95% con- dence intervals (CIs) using a Poisson regression model. All statistical analyses were performed with STATA software (Stata Statistical Software: Release 14, StataCorp, College Station, Texas, USA).
Results
Patient Demographic and Procedural Characteristics
A total of 306 TAVR patients from three high-vol- ume TAVR centers were included in the study. Group I consisted of 188 patients, and Group II consisted of 118 patients. There were 118 patients (38.6%) from the University of Utah, 142 (46.4%) from the Uni- versity of Washington, and 46 (15.0%) from Banner Health Center. Patient demographic characteristics are shown in Table 1. Mean age was 82.5 ± 8.2 years
Tandar A. et al.
Stroke Prevention with Carotid Compression During TAVR