Predictors of early cerebrovascular events after transcatheter aortic valve replacement:a systematic review and meta-analysisOA
Background Early cerebrovascular events(CVEs)following transcatheter aortic valve replacement(TAVR)are severe complications,but effective methods for predicting and preventing these events have not been well established.A systematic review and meta-analysis were performed to identify significant predictors of early CVEs post-TAVR.Methods MEDLINE/Embase databases were searched for articles published between December 2015 and April 2023.Original studies evaluating predictors of CVEs within 30 days post-TAVR after adjusting for confounders were included.Two investigators independently extracted data following the PRISMA statement.Meta-analyses of multivariable data were performed using Der Simonian and Laird random-effects models,with results expressed as odds ratios(ORs)and 95%confidence intervals(CIs).Robustness was assessed via Harbord''s test,nonparametric trim-and-fill analysis,leave-one-out sensitivity analysis,the QUIPS quality assessment tools,meta-regression,and subgroup analyses.Results Among the 74 included studies,multivariate meta-analyses identified 11 predictors of early CVEs,including 9 patientlevel predictors-a CHA2DS2-VASc≥5,no prior heart failure,diabetes,isolated aortic stenosis,carotid artery stenosis,peripheral artery disease,advanced age,New York Heart Association class≥Ⅲ,and significant left ventricular outflow tract calcificationand 2 procedure-level predictors:the absence of cerebral embolization protection and post-dilation.Additionally,10 patient-level factors and 5 procedure-level factors were not associated with early CVEs,although significant heterogeneity was observed in most analyses.Conclusions This study identified multiple patient-level and procedure-level factors associated or not associated with early CVEs after TAVR.These findings support the development of a comprehensive risk prediction model that can accommodate diverse patient populations and evolving procedural techniques,thereby enhancing clinical risk management strategies.
Yi ZHANG;Ying ZHANG;Yi-Jun YAO;Tian-Yuan XIONG;Mao Chen
Department of Cardiology,West China Hospital,Sichuan University,Chengdu,China Laboratory of Cardiac Structure and Function,Institute of Cardiovascular Diseases,West China Hospital,Sichuan University,Chengdu,China Cardiac Structure and Function Research Key Laboratory of Sichuan Province,West China Hospital,Sichuan University,Chengdu,ChinaDepartment of Cardiology,West China Hospital,Sichuan University,Chengdu,China Laboratory of Cardiac Structure and Function,Institute of Cardiovascular Diseases,West China Hospital,Sichuan University,Chengdu,China Cardiac Structure and Function Research Key Laboratory of Sichuan Province,West China Hospital,Sichuan University,Chengdu,ChinaDepartment of Cardiology,West China Hospital,Sichuan University,Chengdu,China Laboratory of Cardiac Structure and Function,Institute of Cardiovascular Diseases,West China Hospital,Sichuan University,Chengdu,China Cardiac Structure and Function Research Key Laboratory of Sichuan Province,West China Hospital,Sichuan University,Chengdu,ChinaDepartment of Cardiology,West China Hospital,Sichuan University,Chengdu,China Laboratory of Cardiac Structure and Function,Institute of Cardiovascular Diseases,West China Hospital,Sichuan University,Chengdu,China Cardiac Structure and Function Research Key Laboratory of Sichuan Province,West China Hospital,Sichuan University,Chengdu,ChinaDepartment of Cardiology,West China Hospital,Sichuan University,Chengdu,China Laboratory of Cardiac Structure and Function,Institute of Cardiovascular Diseases,West China Hospital,Sichuan University,Chengdu,China Cardiac Structure and Function Research Key Laboratory of Sichuan Province,West China Hospital,Sichuan University,Chengdu,China
医药卫生
Meta analysisTranscatheter Aortic Valve Replacementtranscatheter aortic valve replacement tavrcerebrovascular events cves followingPredictorsCHA DS VASc Scoresystematic reviewEarly Cerebrovascular Events
《Journal of Geriatric Cardiology》 2026 (5)
P.309-316,8
supported by the Nature Science Foundation of Sichuan Province(2025ZNSFSC0739 and 2024NSFSC1714)the National Natural Science Foundation of China(U23A20395,82170375)the 1.3.5 project for disciplines of excellence from West China Hospital of Sichuan University(ZYGD23021,23HXFH009)the Science and Technology Projects of Xizang Autonomous Region,China(XZ202501ZY0120)。
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