{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T11:45:26Z","timestamp":1793792726341,"version":"4.6.1"},"reference-count":29,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"unspecified","delay-in-days":127,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,10,22]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Stroke after transcatheter aortic valve implantation (TAVI) is an infrequent but serious complication with important impact on morbidity and mortality. Contemporary real-world evidence on the risk factors of early stroke after TAVI is scarce. We aimed to evaluate the incidence, temporal trends and predictors of in-hospital stroke after TAVI and to assess its association with mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective, observational cohort study using data from the Netherlands Heart Registration of all TAVI procedures performed in the Netherlands between 2013 and 2023. The primary endpoint was the incidence of in-hospital stroke. The secondary endpoints were trends, mortality and risk factors associated with in-hospital stroke and early mortality as identified by logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 23 593 TAVI procedures, the overall incidence of in-hospital stroke was 2.0% and remained stable after an initial decline. Independent covariates associated with in-hospital stroke included female gender (OR 1.29; 95% CI 1.07 to 1.56), peripheral arterial disease (OR 1.55; 95% CI 1.24 to 1.93), non-transfemoral access (OR 1.54; 95% CI 1.21 to 1.93) and postdilation (OR 1.40; 95% CI 1.10 to 1.76). In-hospital stroke was strongly associated with an increased risk of mortality at 30 days (OR 8.54; 95% CI 6.56 to 11.02), and 1 year (OR 4.38; 95% CI 3.55 to 5.40).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In-hospital stroke remains an important complication after TAVI with a strong impact on mortality. Identification of high-risk patients and procedural optimisation is essential in optimisation of outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003630","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T06:25:20Z","timestamp":1762410320000},"page":"e003630","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Trends and risk factors of stroke and mortality after transcatheter aortic valve implantation in the Netherlands"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9755-5859","authenticated-orcid":false,"given":"Simon E","family":"van Putten","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands"},{"name":"Department of Cardiothoracic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romy R M J J","family":"Hegeman","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands"},{"name":"Department of Cardiothoracic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leo","family":"Timmers","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St Antonius Hospital, Nieuwegein, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel C","family":"Overduin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St Antonius Hospital, Nieuwegein, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pythia T","family":"Nieuwkerk","sequence":"additional","affiliation":[{"name":"Department of Medical Psychology, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands"},{"name":"Public Health, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce","family":"Peper","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St Antonius Hospital, Nieuwegein, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maaike M","family":"Roefs","sequence":"additional","affiliation":[{"name":"Netherlands Heart Registration, Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uday","family":"Sonker","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benno J W M","family":"Rensing","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Leiden Universitair Medisch Centrum, Leiden, ZH, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin J","family":"Swaans","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St Antonius Hospital, Nieuwegein, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J M","family":"Klautz","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands"},{"name":"Department of Cardiothoracic Surgery, Leiden Universitair Medisch Centrum, Leiden, ZH, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jurrien","family":"ten Berg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St Antonius Hospital, Nieuwegein, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Klein","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands"},{"name":"Department of Cardiothoracic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,5]]},"reference":[{"key":"2026010701114165000_12.2.e003630.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.110981"},{"key":"2026010701114165000_12.2.e003630.2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab395"},{"key":"2026010701114165000_12.2.e003630.3","doi-asserted-by":"crossref","DOI":"10.3389\/fcvm.2022.958732","article-title":"Stroke prevention during and after transcatheter aortic valve implantation: From cerebral protection devices to antithrombotic management","volume":"9","author":"Jimenez Diaz","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"2026010701114165000_12.2.e003630.4","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1007\/s00392-022-01997-1","article-title":"A systematic review and meta-analysis of the cerebrovascular event incidence after transcatheter aortic valve implantation","volume":"111","author":"Meertens","year":"2022","journal-title":"Clin Res Cardiol"},{"key":"2026010701114165000_12.2.e003630.5","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCINTERVENTIONS.121.011358","article-title":"Characterization of Cerebral Embolic Capture Using the SENTINEL Device During Transcatheter Aortic Valve Implantation in Low to Intermediate-Risk Patients: The SENTINEL-LIR Study","volume":"15","author":"Kawakami","year":"2022","journal-title":"Circ Cardiovasc 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Stroke","volume":"12","author":"Vlastra","year":"2019","journal-title":"Circ Cardiovasc Interv"},{"key":"2026010701114165000_12.2.e003630.12","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.26612"},{"key":"2026010701114165000_12.2.e003630.13","doi-asserted-by":"crossref","first-page":"e793","DOI":"10.4244\/EIJ-D-23-01087","article-title":"Cerebrovascular events after transcatheter aortic valve implantation","volume":"20","author":"Reddy","year":"2024","journal-title":"EuroIntervention"},{"key":"2026010701114165000_12.2.e003630.14","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1007\/s12471-022-01672-0","article-title":"Using real-world data to monitor and improve quality of care in coronary artery disease: results from the Netherlands Heart Registration","volume":"30","author":"Timmermans","year":"2022","journal-title":"Neth Heart J"},{"key":"2026010701114165000_12.2.e003630.15","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1007\/s12471-024-01877-5","article-title":"Building a patient-centred nationwide integrated cardiac care registry: intermediate results from the Netherlands","volume":"32","author":"Derks","year":"2024","journal-title":"Neth Heart J"},{"key":"2026010701114165000_12.2.e003630.16","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1007\/s12471-022-01752-1","article-title":"Data quality and auditing within the Netherlands Heart Registration: using the PCI registry as an example","volume":"31","author":"Houterman","year":"2023","journal-title":"Neth Heart J"},{"key":"2026010701114165000_12.2.e003630.17","doi-asserted-by":"crossref","first-page":"100961","DOI":"10.1016\/j.cpcardiol.2021.100961","article-title":"Trends and Outcomes of Ischemic Stroke after Transcatheter Aortic Valve Implantation, A US National Propensity Matched Analysis","volume":"47","author":"Zahid","year":"2022","journal-title":"Curr Probl Cardiol"},{"key":"2026010701114165000_12.2.e003630.18","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.amjcard.2023.11.024","article-title":"Temporal Trends in Patient Characteristics and Outcomes of Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement: A Nationwide Study","volume":"211","author":"Lundahl","year":"2024","journal-title":"Am J Cardiol"},{"key":"2026010701114165000_12.2.e003630.19","article-title":"Aortic Valve Calcium Score Is Associated With Acute Stroke in Transcatheter Aortic Valve Replacement Patients","volume":"1","author":"Foley","year":"2022","journal-title":"J Soc Cardiovasc Angiogr Interv"},{"key":"2026010701114165000_12.2.e003630.20","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.amjcard.2023.04.031","article-title":"Meta-Analysis of the Prognostic Significance of Carotid Artery Stenosis in Patients Who Underwent Transcatheter Aortic Valve Implantation","volume":"200","author":"Vella","year":"2023","journal-title":"Am J Cardiol"},{"key":"2026010701114165000_12.2.e003630.21","doi-asserted-by":"publisher","DOI":"10.4244\/EIJV9SSA4"},{"key":"2026010701114165000_12.2.e003630.22","doi-asserted-by":"crossref","first-page":"131353","DOI":"10.1016\/j.ijcard.2023.131353","article-title":"Transaxillary versus transfemoral access as default access in TAVI: A propensity matched analysis","volume":"394","author":"van Wely","year":"2024","journal-title":"Int J Cardiol"},{"key":"2026010701114165000_12.2.e003630.23","first-page":"1427","article-title":"Transfemoral vs Non-transfemoral Access for Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis","volume":"31","author":"Chandrasekhar","year":"2015","journal-title":"Can J 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Transcatheter Aortic Valve Replacement and Their Predictors: A Report From the CoreValve Trials","volume":"9","author":"Kleiman","year":"2016","journal-title":"Circ Cardiovasc Interv"},{"key":"2026010701114165000_12.2.e003630.28","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1016\/j.amjcard.2016.07.011","article-title":"Meta-Analysis of Perioperative Stroke and Mortality in Transcatheter Aortic Valve Implantation","volume":"118","author":"Muralidharan","year":"2016","journal-title":"Am J Cardiol"},{"key":"2026010701114165000_12.2.e003630.29","doi-asserted-by":"crossref","first-page":"351","DOI":"10.3988\/jcn.2017.13.4.351","article-title":"Perioperative Stroke, In-Hospital Mortality, and Postoperative Morbidity Following Transcatheter Aortic Valve Implantation: A Nationwide Study","volume":"13","author":"Thirumala","year":"2017","journal-title":"J Clin Neurol"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2025-003630","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T09:11:49Z","timestamp":1767777109000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2025-003630"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":29,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,11,5]]},"published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1136\/openhrt-2025-003630"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2025-003630","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}