Neurological Complications After Transcatheter Versus Surgical Aortic Valve Replacement in Intermediate-Risk Patients

The authors of this study analyzed neurological events and quality-of-life in the Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI) trial.  A total of 1746 patients with aortic stenosis and intermediate surgical risk were randomized to either TAVI or SAVR. Neurological events and quality of life were analyzed at 30 days, six months, and 12 months. In this group of elderly (approximately 80 years old) patients with an intermediate risk profile (STS-PROM 4.5), the event rates at 30 days were higher for SAVR as compared with TAVI for both stroke and encephalopathy (5.4% vs. 3.3%, p=0.031 and 7.8% vs. 1.6%; p<0.0001, respectively). There were no differences in the incidence of late strokes (TAVI 2.0% vs. SAVR 1.5%). Neurological events were associated with increased mortality at one year. Quality of life after an early stroke in TAVI patients was higher than in SAVR patients who suffered from a stroke.  The thoroughness and consistency in stroke assessment in this trial is a major strength. Whereas the early PARTNER IA trial showed a higher stroke rate with TAVI than with SAVR (4.7% vs. 2.4% respectively), these results show a more favorable outcome for strokes after TAVI.  Interestingly, no embolic protection devices were used in the trial. Application of these devices is now more and more common and might further reduce stroke rate after TAVI. The results of this study provide further evidence supporting TAVI in intermediate risk patients.