Risk Factors and Prognosis of Silent Cerebral Infarction After Transcatheter Aortic Valve Replacement

Risk Factors and Prognosis of Silent Cerebral Infarction After Transcatheter Aortic Valve Replacement | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Risk Factors and Prognosis of Silent Cerebral Infarction After Transcatheter Aortic Valve Replacement Shuguang Wu, Yi Liu, Tingting Ni, Tao Lv, Yuanyuan Yao, Min Yan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5948260/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Apr, 2025 Read the published version in Scientific Reports → Version 1 posted 8 You are reading this latest preprint version Abstract Background The Valve Academic Research Consortium (VARC)-3 definition of silent cerebral infarction among neurologic events after transcatheter aortic valve replacement (TAVR) lacks clinical validation, yet its impact on postoperative in-hospital outcomes and long-term prognosis remains uncertain. Objectives This study aims to explore the perioperative related factors influencing the risk of SCI post-TAVR as defined by VARC-3 criteria, so as to identify high-risk individuals early and assess the effect of SCI on patient outcomes and one-year mortality following TAVR. Methods This was a single-center study including 613 patients with severe aortic stenosis undergoing TAVR, with all data collected prospectively in a dedicated database.We compared clinical baseline data, preoperative imaging results, perioperative factors, and intraoperative variables between patients with and without SCI according to VARC-3. Multivariate logistic regression was used to identify risk factors associated with SCI. Propensity score matching (PSM) at a 1:2 ratio was employed based on fundamental characteristics such as age, gender, BMI, and medical history to minimize potential confounding. Post-matching, we analyzed differences in postoperative in-hospital outcomes and other results between the two groups. Survival times were compared using the Kaplan-Meier method, and survival curves were plotted. The log-rank test assessed statistical differences between the survival curves. Furthermore, univariate and multivariate Cox regression analyses were conducted to determine risk factors for one-year postoperative mortality. Results Out of 827 TAVR patients screened, 613 were included in the final analysis—471 in the SCI group and 142 in the non-SCI group—resulting in an incidence rate of 76.8% for SCI. The occurrence of post-induction hypotension was significantly higher in the SCI group compared to the non-SCI group (70.28% vs. 61.27%, P = 0.043). Multivariate logistic regression revealed that post-induction hypotension lasting less than 10 minutes (odds ratio [OR]: 1.73; 95% confidence interval [CI]: 1.13–3.26; P = 0.009), hypotension lasting more than 10 minutes (OR: 1.98; 95% CI: 1.18–3.33; P = 0.01), and postoperative tachyarrhythmia (OR: 1.98; 95% CI: 1.27–3.07; P = 0.002) were significant risk factors for developing SCI after TAVR. Following 1:2 PSM, 416 patients remained—274 in the SCI group and 142 in the non-SCI group. After matching, the SCI group had a notably higher incidence of postoperative delirium compared to the non-SCI group (9.12% vs. 2.82%; P = 0.017), and their one-year mortality rate was also elevated (5.47% vs. 0.70%; P = 0.016). Additionally, multivariate Cox regression analysis indicated that elevated preoperative creatinine levels (hazard ratio [HR]: 1.01; 95% CI: 1.01–1.02; P = 0.011), presence of SCI (HR: 10.81; 95% CI: 1.31–89.18; P = 0.027), Society of Thoracic Surgeons (STS) score greater than 7% (HR: 3.32; 95% CI: 1.07–10.33; P < 0.038), age 75 years or older (HR: 7.86; 95% CI: 1.01–14.47; P = 0.049), and a history of stroke (HR: 7.20; 95% CI: 2.32–22.35; P < 0.001) were independent risk factors for one-year mortality post-TAVR. Conclusion Our findings suggest that post-induction hypotension and postoperative tachyarrhythmia are significant risk factors for SCI following TAVR as defined by VARC-3 criteria. Patients who developed SCI after TAVR exhibited higher rates of postoperative delirium and increased one-year mortality compared to those without this complication. Furthermore, factors such as elevated preoperative creatinine levels, an STS score above 7%, age of 75 years or older, and a prior history of stroke were associated with higher one-year mortality rates after TAVR. Given the negative impact of occult SCI on clinical outcomes, every effort should be made to reduce the risk of neurological complications after TAVR. Health sciences/Medical research Health sciences/Neurology Health sciences/Risk factors Transcatheter Aortic Valve Replacement VARC-3 Silent Cerebral Infarction Risk Factors Clinical Outcomes Postoperative Delirium Mortality Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 29 Apr, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Accepted 17 Apr, 2025 Reviews received at journal 15 Apr, 2025 Reviews received at journal 14 Apr, 2025 Reviewers agreed at journal 14 Apr, 2025 Reviewers agreed at journal 14 Apr, 2025 Reviewers invited by journal 14 Apr, 2025 Submission checks completed at journal 11 Apr, 2025 First submitted to journal 30 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5948260","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":442824573,"identity":"192c5684-91a5-4605-a912-b2e4986eb5b7","order_by":0,"name":"Shuguang Wu","email":"","orcid":"","institution":"The Second Affiliated Hospital Zhejiang University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Shuguang","middleName":"","lastName":"Wu","suffix":""},{"id":442824574,"identity":"a939d255-a5aa-425e-be5a-8160f2cc045b","order_by":1,"name":"Yi Liu","email":"","orcid":"","institution":"The Second Affiliated Hospital Zhejiang 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Replacement","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Transcatheter Aortic Valve Replacement, VARC-3, Silent Cerebral Infarction, Risk Factors, Clinical Outcomes, Postoperative Delirium, Mortality","lastPublishedDoi":"10.21203/rs.3.rs-5948260/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5948260/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\n\u003cp\u003eThe Valve Academic Research Consortium (VARC)-3 definition of silent cerebral infarction among neurologic events after transcatheter aortic valve replacement (TAVR) lacks clinical validation, yet its impact on postoperative in-hospital outcomes and long-term prognosis remains uncertain.\u003c/p\u003e\n\u003cp\u003eObjectives\u003c/p\u003e\n\u003cp\u003eThis study aims to explore the perioperative related factors influencing the risk of SCI post-TAVR as defined by VARC-3 criteria, so as to identify high-risk individuals early and assess the effect of SCI on patient outcomes and one-year mortality following TAVR.\u003c/p\u003e\n\u003cp\u003eMethods\u003c/p\u003e\n\u003cp\u003eThis was a single-center study including 613 patients with severe aortic stenosis undergoing TAVR, with all data collected prospectively in a dedicated database.We compared clinical baseline data, preoperative imaging results, perioperative factors, and intraoperative variables between patients with and without SCI according to VARC-3. Multivariate logistic regression was used to identify risk factors associated with SCI. Propensity score matching (PSM) at a 1:2 ratio was employed based on fundamental characteristics such as age, gender, BMI, and medical history to minimize potential confounding. Post-matching, we analyzed differences in postoperative in-hospital outcomes and other results between the two groups. Survival times were compared using the Kaplan-Meier method, and survival curves were plotted. The log-rank test assessed statistical differences between the survival curves. Furthermore, univariate and multivariate Cox regression analyses were conducted to determine risk factors for one-year postoperative mortality.\u003c/p\u003e\n\u003cp\u003eResults\u003c/p\u003e\n\u003cp\u003eOut of 827 TAVR patients screened, 613 were included in the final analysis—471 in the SCI group and 142 in the non-SCI group—resulting in an incidence rate of 76.8% for SCI. The occurrence of post-induction hypotension was significantly higher in the SCI group compared to the non-SCI group (70.28% vs. 61.27%, P = 0.043). Multivariate logistic regression revealed that post-induction hypotension lasting less than 10 minutes (odds ratio [OR]: 1.73; 95% confidence interval [CI]: 1.13–3.26; P = 0.009), hypotension lasting more than 10 minutes (OR: 1.98; 95% CI: 1.18–3.33; P = 0.01), and postoperative tachyarrhythmia (OR: 1.98; 95% CI: 1.27–3.07; P = 0.002) were significant risk factors for developing SCI after TAVR. Following 1:2 PSM, 416 patients remained—274 in the SCI group and 142 in the non-SCI group. After matching, the SCI group had a notably higher incidence of postoperative delirium compared to the non-SCI group (9.12% vs. 2.82%; P = 0.017), and their one-year mortality rate was also elevated (5.47% vs. 0.70%; P = 0.016). Additionally, multivariate Cox regression analysis indicated that elevated preoperative creatinine levels (hazard ratio [HR]: 1.01; 95% CI: 1.01–1.02; P = 0.011), presence of SCI (HR: 10.81; 95% CI: 1.31–89.18; P = 0.027), Society of Thoracic Surgeons (STS) score greater than 7% (HR: 3.32; 95% CI: 1.07–10.33; P \u0026lt; 0.038), age 75 years or older (HR: 7.86; 95% CI: 1.01–14.47; P = 0.049), and a history of stroke (HR: 7.20; 95% CI: 2.32–22.35; P \u0026lt; 0.001) were independent risk factors for one-year mortality post-TAVR.\u003c/p\u003e\n\u003cp\u003eConclusion\u003c/p\u003e\n\u003cp\u003eOur findings suggest that post-induction hypotension and postoperative tachyarrhythmia are significant risk factors for SCI following TAVR as defined by VARC-3 criteria. Patients who developed SCI after TAVR exhibited higher rates of postoperative delirium and increased one-year mortality compared to those without this complication. Furthermore, factors such as elevated preoperative creatinine levels, an STS score above 7%, age of 75 years or older, and a prior history of stroke were associated with higher one-year mortality rates after TAVR. Given the negative impact of occult SCI on clinical outcomes, every effort should be made to reduce the risk of neurological complications after TAVR.\u003c/p\u003e","manuscriptTitle":"Risk Factors and Prognosis of Silent Cerebral Infarction After Transcatheter Aortic Valve Replacement","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-15 13:09:40","doi":"10.21203/rs.3.rs-5948260/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2025-04-17T07:49:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-15T12:34:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-15T03:02:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"222827051209058430104125321453440082121","date":"2025-04-15T02:57:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"112327226076339097703756570468274781197","date":"2025-04-14T15:54:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-14T13:31:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-11T11:14:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-03-30T08:15:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3cc40c30-bade-45a5-b38e-ce61131451cc","owner":[],"postedDate":"April 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":47144020,"name":"Health sciences/Medical research"},{"id":47144021,"name":"Health sciences/Neurology"},{"id":47144022,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2025-05-05T16:02:43+00:00","versionOfRecord":{"articleIdentity":"rs-5948260","link":"https://doi.org/10.1038/s41598-025-99173-8","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-04-29 15:57:22","publishedOnDateReadable":"April 29th, 2025"},"versionCreatedAt":"2025-04-15 13:09:40","video":"","vorDoi":"10.1038/s41598-025-99173-8","vorDoiUrl":"https://doi.org/10.1038/s41598-025-99173-8","workflowStages":[]},"version":"v1","identity":"rs-5948260","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5948260","identity":"rs-5948260","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}