Post-TAVI stroke occurred in 1.4% of patients prior to discharge, did not decline over time, and strongly predicted 12-month all-cause mortality (adjusted HR 7.8; 95% CI 3.9-15.7; p<0.001).
Cohort (n=3,823)
Yes
What are the incidence, predictors, and outcomes of stroke following transcatheter aortic valve implantation in a contemporary cohort?
Stroke remains an uncommon but serious complication of TAVI (1.4% incidence) that has not decreased over time and is strongly associated with 12-month mortality.
Stroke is a serious complication following transcatheter aortic valve implantation, associated with increased disability and mortality. Despite this, there is a lack of patient-level data examining stroke in contemporary, lower-risk TAVI populations and limited literature exploring the temporal evolution in stroke-incidence among real-world cohorts. We aimed to assess the incidence, predictors and outcomes of stroke in a modern group of TAVI patients across the clinical risk spectrum. We performed a retrospective analysis of prospectively collected data from 2014 to 2025 included in an Australian multi-centre registry. Stroke and other outcome measures were defined in accordance with the Valve Academic Research Consortium-3 guidelines. Of 3823 patients, median age 82 (IQR: 77, 86), 60% male and median STS score 3.3 (2.0, 5.3), 54 (1.4%) patients experienced a stroke prior to hospital discharge. Stroke incidence did not reduce across the study period (2014-2017: 0.8% vs 2018-2021: 1.4% vs 2022-2025: 1.5%, Ptrend=0.651). Independent predictors of stroke were prior radiotherapy (adjusted odds ratio aOR: 2.8, 95% CI 1.1-7.3, p=0.033), use of a self-expanding valve (aOR: 2.9, 95% CI 1.4-6.1, p=0.004) and non-femoral access (aOR 3.6, 95% CI 1.1-12.2, p=0.040). Post-TAVI stroke was a strong predictor of 12-month all-cause mortality in Cox proportional hazards regression modelling (adjusted hazard ratio: 7.8, 95% CI 3.9-15.7, p<0.001). In conclusion, stroke remains an uncommon but serious TAVI complication in contemporary practice patients. Despite demographic and procedural evolution, there was no reduction in stroke incidence across the study-period. Further research investigating novel strategies for stroke prevention is required.
Butala et al. (2026) conducted a cohort in Transcatheter aortic valve implantation (n=3,823). Transcatheter aortic valve implantation was evaluated on Stroke prior to hospital discharge. Post-TAVI stroke occurred in 1.4% of patients prior to discharge, did not decline over time, and strongly predicted 12-month all-cause mortality (adjusted HR 7.8; 95% CI 3.9-15.7; p<0.001).