Author + information
- Jeremy Ben-Shoshan1,
- David Zahler2,
- Arie Steinvil3,
- Shmuel Banai4,
- Gad Keren4,
- Natan M. Bornstein1,
- Ariel Finkelstein4 and
- Amir Halkin5
This study sought to assess the impact of carotid artery stenosis (CAS) on outcomes of patients undergoing transcatheter aortic valve replacement (TAVR). CAS has been associated with the risk of stroke in patients undergoing cardiac surgery. However, little is known about the clinical significance of CAS in the setting of TAVR.
Consecutive patients (n=312) with severe symptomatic aortic stenosis who underwent a carotid Doppler study immediately prior to TAVR were followed prospectively. Major adverse cardiovascular event (MACE) rates were stratified by the presence of CAS, defined in accodance with current guidelines.
Carotid atherosclerosis (CA, defined as any carotid plaque) was present in 301 (96.5%) patients and CAS (peak systolic velocity [PSV]≥125cm/sec; ≥50% diameter stenosis) in 97 (31.1%). Severe CAS (PSV≥230 cm/sec; ≥70% stenosis, or near occlusion) was found in 20 (6.4%) patients. During hospitalization similar rates of primary composite MACE endpoint (10.7% vs. 8.2%, p=0.503) and its individual components (all-cause mortality, stroke, myocardial infarction (MI), acute heart failure (HF) [4.2% vs. 5.2%, p=0.769; 1.9% vs. 0%, p=0.314; 0% vs. 0%; and 5.5% vs. 3.0%, p=0.407 respectively]) were observed for patients without and with CAS. Similarly, at long-term follow-up (248±205 days), the rates of MACE (20.9% vs. 19.6%, p=0.786) and its individual components (all-cause mortality, stroke, MI, readmission for HF [19.5%% vs. 14.4%%, p=0.277; 3.3% vs. 2.1%, p=0.726; 1.4% vs. 0%, p=0.555; and 7.9% vs.8.2%, p=0.918 respectively]) did not significantly differ between patients without versus those with CAS. By multivariate cox regression analysis, atrial fibrillation (HR=1.853, [95%CI 1.097 to 3.129], p=0.021), but not CAS (HR=0.749, [95%CI 0.389 to 1.443], p=0.388), independently correlated with late MACE rates in the entire cohort.
Though common among TAVR candidates, CAS was not associated with worse outcomes following TAVR. The relative prognostic significance of CAS in patients considered for either surgical or transcatheter valve replacement merits further research.
STRUCTURAL: Valvular Disease: Aortic