Association of Bovine Arch Anatomy With Incident Stroke After Transcatheter Aortic Valve Replacement
Document Type
Article
Publication Date
2-20-2024
Department
Department of Biomedical Engineering
Abstract
BACKGROUND: Acute ischemic stroke complicates 2 % to 3 % of transcatheter aortic valve replacements (TAVRs). This study aimed to identify the aortic anatomic correlates in patients after TAVR stroke. METHODS AND RESULTS: This is a single-center, retrospective study of patients who underwent TAVR at the Mayo Clinic between 2012 and 2022. The aortic arch morphology was determined via a manual review of the pre-TAVR computed tomography images. An "a priori" approach was used to select the covariates for the following: (1) the logistic regression model assessing the association between a bovine arch and periprocedural stroke (defined as stroke within 7 days after TAVR) and (2) the Cox proportional hazards regression model assessing the association between a bovine arch and long-term stroke after TAVR. A total of 2775 patients were included (59.6 % men, 97.8 % White race, mean ± SD age, 79.3 ± 8.4 years), of whom 495 (17.8 %) had a bovine arch morphology. Fifty-seven patients (1.7 %) experienced a periprocedural stroke. The incidence of acute stroke was significantly higher among patients with a bovine arch compared with those with a nonbovine arch (3.6% versus 1.7%; =0.01). After adjustment, a bovine arch was independently associated with increased periprocedural strokes (adjusted odds ratio, 2.16 [95 % CI, 1.22-3.83]). At a median follow-up of 2.7 years, the overall incidence of post-TAVR stroke was 6.0 % and was significantly higher in patients with a bovine arch even after adjusting for potential confounders (10.5 % versus 5.0 % adjusted hazard ratio, 2.11 [95 % CI, 1.51-2.93], < 0.001). CONCLUSIONS: A bovine arch anatomy is associated with a significantly higher risk of periprocedural and long-term stroke after TAVR.
Publication Title
Journal of the American Heart Association
Recommended Citation
Lo Russo, G. V.,
Alarouri, H. S.,
Al-Abcha, A.,
Vogl, B.,
Mahayni, A.,
Sularz, A.,
Hatoum, H.,
Collins, J.,
Crestanello, J. A.,
&
Alkhouli, M.
(2024).
Association of Bovine Arch Anatomy With Incident Stroke After Transcatheter Aortic Valve Replacement.
Journal of the American Heart Association,
13(4), e032963.
http://doi.org/10.1161/JAHA.123.032963
Retrieved from: https://digitalcommons.mtu.edu/michigantech-p2/556
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Version
Publisher's PDF
Publisher's Statement
© 2024 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. Publisher’s version of record: https://doi.org/10.1161/JAHA.123.032963