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Surgeon Q&A: Can I Get TAVR After Stroke?

Written By: Adam Pick, Patient Advocate, Author & Website Founder
Medical Expert: Marc Gerdisch, MD, Chief of Cardiac Surgery, Franciscan Health
Published: November 16, 2023

In our ongoing discussion about stroke risk associated with transcatheter aortic valve replacement (TAVR), I just received a great question from Joel.  In his email, Joel writes, “Hi Adam, I have had aortic stenosis for about 3 years. My cardiologist sent me to see a surgeon last week. I also had a stroke about 3 years ago in addition to a heart attack about 30 years ago. I watched a video of yours with Dr. Marc Gerdisch about stroke risk. My question is, ‘Am I a good TAVR candidate being that I already had a stroke?’”

TAVR After Stroke
 

To provide Joel an expert response about stroke and TAVR, I wasted no time reaching out to Dr. Marc Gerdisch. As you may know, Dr. Gerdisch has performed over 4,000 heart valve operations during his career. In our community, Dr. Gerdisch has successfully treated over 125 patients.

Dr. Marc Gerdisch

Dr. Gerdisch Says…

Here is a response to Joel’s question from Dr. Gerdisch:

Joel asks an important question because a history of stroke requires a detailed assessment of its mechanisms. Strokes can arise from clot in the heart related to atrial fibrillation, blockage of blood vessels to the brain, congenital abnormalities of the brain blood vessels, condition that cause blood to clot inappropriately, debris breaking off from inside a blood vessel, and other sources. As such, the approach to a patient with a history of stroke requires evaluation of the cause of the stroke and its relevance to the planned procedure, whether TAVR or surgical aortic valve replacement (SAVR).

There is risk of stroke with any aortic valve procedure. The nature of a prior stroke and its cause may play a role in selecting a procedure.

Stroke Risk After TAVR (Brain Xray)Stroke After TAVR Xray (Source: TCTMD)

It is worth noting that not only obvious strokes may occur at the time of a procedure but also small injuries to the brain are seen in many patients. In fact, with modern neuro imaging, the great majority of patients examined after TAVR have new brain lesions. They are multiple and small, and at present we do not have a clear understanding of the long-term consequences.

Risks for stroke at the time of SAVR or TAVR are largely related to the procedures but are influenced by patient conditions such as vascular disease, kidney disease, diabetes, and hypertension.

That said, Joel may be best treated with either TAVR or SAVR. His history of stroke is only one risk factor to be considered. As always, the decision for a valve procedure is dependent on an algorithmic approach that balances to nuances of risk factors, patient frailty, and patient goals. — Dr. Marc Gerdisch

Thanks Joel & Dr. Gerdisch!

Thanks to Joel for his question about strokes and TAVR. And, many thanks to Dr. Gerdisch for sharing his clinical experiences and research with our patient community!

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Keep on tickin,
Adam