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 transcatheter aortic valve implantation (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 multicenter registry. Stroke and other outcome measures were defined in accordance with the Valve Academic Research Consortium-3 guidelines. Of 3,823 patients, median age 82 (interquartile range [IQR]: 77, 86), 60% male, and median STS score 3.3 (2.0, 5.3), 54 (1.4%) patients experienced a stroke before hospital discharge. Stroke incidence did not reduce across the study period (2014 to 2017: 0.8% vs 2018 to 2021: 1.4% vs 2022 to 2025: 1.5%, ptrend = 0.651). Independent predictors of stroke were previous radiotherapy (adjusted odds ratio [aOR]: 2.8, 95% CI 1.1 to 7.3, p = 0.033), use of a self-expanding valve (aOR: 2.9, 95% CI 1.4 to 6.1, p = 0.004), and nonfemoral access (aOR 3.6, 95% CI 1.1 to 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 to 15.7, p < 0.001). In conclusion, stroke remains an uncommon but serious TAVI complication in contemporary practice. 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.
Keywords: aortic stenosis; outcomes; predictors; stroke; transcatheter aortic valve implantation.
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