{"id":4730,"date":"2024-07-19T16:27:21","date_gmt":"2024-07-19T16:27:21","guid":{"rendered":"https:\/\/www.heart-valve-surgery.com\/learning\/?page_id=4730"},"modified":"2024-07-29T21:58:41","modified_gmt":"2024-07-29T21:58:41","slug":"stroke-risk-prevention-during-tavr","status":"publish","type":"page","link":"https:\/\/www.heart-valve-surgery.com\/learning\/stroke-risk-prevention-during-tavr\/","title":{"rendered":"Doctor Q&#038;A: Stroke Risk &#038; Prevention During Transcatheter Aortic Valve Replacement (TAVR)"},"content":{"rendered":"<p>The treatment of aortic valve stenosis has transformed with the advent of the <a href=\"https:\/\/www.heart-valve-surgery.com\/medtronic-tavr-procedure\">transcatheter aortic valve replacement (TAVR) procedure<\/a>. Originally approved for patients who were too high risk to tolerate open heart surgery, TAVR is now received approval for patients at all surgical risk levels. In many instances, this minimally-invasive approach allows patients to go home the next day after the procedure<sup>1<\/sup>, and most patients can take care of themselves better, go back to their everyday activities and tend to have a faster recovery compared to open heart surgery<sup>2<\/sup>.<\/p>\n<p>However, TAVR is not perfect.\u00a0 Like many cardiac procedures, including surgical aortic valve replacement, TAVR comes with the risk of stroke during the procedure. Although statistics show the stroke risk is low, the threat of having a stroke during a TAVR remains a serious complication.<sup>3\u00a0 <\/sup><\/p>\n<p>To get more information about TAVR and the risk of stroke, we spoke with <a href=\"https:\/\/bit.ly\/46fwxZS\">Dr. Kendra Grubb<\/a>, the surgical director of the Emory Structural Heart and Valve Center at Emory Healthcare in Atlanta, Georgia. Dr. Grubb has performed over a thousand cardiac surgeries and TAVRs. In fact, she was scheduled to perform three procedures the day she spoke with us.<\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/3UL4_CwOMJU?rel=0\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n<p>&nbsp;<\/p>\n<h2>Key Learnings About Stroke Risk and TAVR<\/h2>\n<ul>\n<li><strong>The rate of stroke remains stable. <\/strong> Grubb stated, \u201cThe stroke rate has been pretty stable for a number of years. Initially, there was a higher stroke rate with TAVR than with surgery, but that\u2019s not true anymore. The rate of stroke is about two to three percent, and it has been for a really long time. With modern devices and modern techniques, that rate is probably closer to two.\u201d<sup>3<\/sup><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-4734 size-full\" src=\"https:\/\/www.heart-valve-surgery.com\/learning\/..\/Images\/tavr-stroke-risk-percent.jpg\" alt=\"Transcatheter Aortic Valve Replacement (TAVR) Stroke Rate\" width=\"500\" height=\"278\" \/><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Cerebral protection devices can help decrease the rate of disabling stroke. <\/strong> Grubb told us, \u201cWe do have cerebral protection devices or brain protection devices that put little baskets in the arteries that go to the brain. Those trials have shown that it decreases the rates of disabling strokes &#8211; so the ones that count.<sup>4<\/sup><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-4736 aligncenter\" src=\"https:\/\/www.heart-valve-surgery.com\/learning\/..\/Images\/cerebral-protection-devices-stroke.jpg\" alt=\"Cerebral Protection Device to Prevent Stroke During TAVR\" width=\"500\" height=\"246\" \/><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Clinical trial research is being conducted to evaluate new devices that may help reduce the stroke risk. <\/strong>\u201cThe data right now does not necessarily support the use of embolic protection devices,\u201d Dr. Grubb said. \u201cThere are newer devices in trial that may show a bigger difference. Even the commercially available device, the Sentinel Cerebral Protection Device, has some data to say that it\u2019s worth doing.\u201d<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>What is Dr. Grubb\u2019s advice for patients concerned about stroke during TAVR? <\/strong>Dr. Grubb stated, \u201cMy advice to patients is to have the conversation with your doctor, understand the data, understand if you think that this is something that will benefit you. Your doctor will look at your CT scan and be able to tell you if you\u2019re at a higher risk for having a stroke and then make the decision and share decision-making with the team that\u2019s taking care of you.\u201d\u00a0 TAVR risks may include, but are not limited to, death, stroke, damage to the arteries, bleeding and need for permanent pacemaker.<\/p>\n<p>The statements and information presented herein may be the opinion of the individual physician featured and is not intended to constitute medical advice.<\/p>\n<p>&nbsp;<\/p>\n<h2>Thanks Dr. Grubb and Emory Structural Heart and Valve Center!<\/h2>\n<p>On behalf of the patients at HeartValveSurgery.com and all over the world, thank you, Dr. Grubb, for sharing your expert knowledge and advice about TAVR, stroke, and cerebral protection devices.<\/p>\n<p>Related Links:<\/p>\n<ul>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/medtronic-tavr-procedure\">Medtronic TAVR Procedure: What Should Patients Know?<\/a><\/li>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/medtronic-tavr-heart-team-finder\">TAVR Heart Team Finder<\/a><\/li>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/learning\/medtronic-evolut-low-risk-tavr-clinical-trial-results\/\">Clinical Trial Update: 4-Year Results for Low-Risk TAVR Clinical Trial<\/a><\/li>\n<\/ul>\n<p>Keep on tickin!<br \/>\nAdam<\/p>\n<p>P.S. For the deaf and hard-of-hearing members of our patient community, I have provided a transcript of this interview with Dr. Grubb below.<\/p>\n<p>References:<\/p>\n<p><sup>1 <\/sup>Batchelor WB, Sanchez CE, Sorajja P, et al. Temporal Trends, Outcomes, and Predictors of Next-Day Discharge and Readmission Following Uncomplicated Evolut Transcatheter Aortic Valve Replacement: A Propensity Score-Matched Analysis. J Am Heart Assoc. May 7 2024;13(9):e033846.<\/p>\n<p><sup>2<\/sup> Kleiman NS, Van Mieghem NM, Reardon MJ, et al. Quality of Life 5 Years Following Transfemoral TAVR or SAVR in Intermediate Risk Patients. JACC Cardiovasc Interv. Apr 22 2024;17(8):979-988.<\/p>\n<p><sup>3 <\/sup>Carroll JD, Mack MJ, Vemulapalli S, et al. STS-ACC TVT Registry of Transcatheter Aortic Valve Replacement. Journal of the American College of Cardiology. 2020\/11\/24\/ 2020;76(21):2492-2516.\u00a0Based on 30-day stroke rates from Transcatheter Valve Therapy Registry.<\/p>\n<p><sup>4 <\/sup>Wolfrum M, Handerer IJ, Moccetti F, Schmeisser A, Braun-Dullaeus RC, Toggweiler S. Cerebral embolic protection during transcatheter aortic valve replacement: a systematic review and meta-analysis of propensity score matched and randomized controlled trials using the Sentinel cerebral embolic protection device. BMC Cardiovasc Disord. 2023 Jun 17;23(1):306.<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":4,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"cms.php","meta":{"_acf_changed":false,"footnotes":""},"categories":[6],"class_list":["post-4730","page","type-page","status-publish","hentry","category-aortic-valve-replacement"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/4730","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/comments?post=4730"}],"version-history":[{"count":13,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/4730\/revisions"}],"predecessor-version":[{"id":4770,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/4730\/revisions\/4770"}],"wp:attachment":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/media?parent=4730"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/categories?post=4730"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}