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Background: Stroke remains one of the most devastating complications of transcatheter aortic valve implantation (TAVI). The aim of this study was to identify the incidence, timing, temporal trends, and predictors of stroke after TAVI and evaluate the outcomes of patients with stroke. Methods and Results: The CENTER-Collaboration is an international collaboration consisting of 3 national registries and 7 local registries or prospective clinical trials, selected through a systematic review. Accordingly, a total of 10 982 patients undergoing transfemoral TAVI between 2007 and 2018 were included in the current patient-level pooled analyses. A total of 261 patients (2.4%) experienced stroke during the first month after TAVI. The median time between TAVI and stroke was 1 day (interquartile range, 0–6 days). The stroke rate was comparable in procedures performed in the early years of TAVI (2007–2012) to those in the more recent years of TAVI (2013–2018; both 2.4%; P =1.0). Independent predictors of stroke at 30 days were a history of cerebrovascular events (odds ratio, 2.2; 95% CI, 1.4–3.6; P =0.0012) and a glomerular filtration rate of <30 mL/min per 1.73 m 2 (odds ratio, 1.7; 95% CI, 1.0–2.8; P =0.05). Stroke occurring within the first 30 days after TAVI was associated with a 6-fold increase of 30-day mortality (odds ratio, 6.0; 95% CI, 4.4–8.1; P <0.001). Moreover, patients with stroke more frequently had documented new-onset atrial fibrillation (16% versus 3%; P <0.001) and major or life-threatening bleedings (12% versus 7%; P =0.002) at 30-day follow-up. Conclusions: In this large, global, patient-level analysis, the incidence of stroke after transfemoral TAVI was 2.4%. Prior cerebrovascular events and a low glomerular filtration rate independently predicted the occurrence of stroke after TAVI. The occurrence of stroke after TAVI was associated with a strikingly 6-fold increase of 30-day mortality; additionally, there was a 5-fold higher rate of new-onset atrial fibrillation in patients with stroke. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03588247.

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Although overall values did not change after TAVI, iFR presented significant and mostly erratic individual variations after valve replacement. Delta iFR was influenced by the extent of the transaortic gradient drop induced by TAVI. Therefore, caution is advisable in the interpretation of iFR in the presence of AS.

BackgroundManagement of coronary artery disease in patients undergoing transcatheter aortic valve implantation is uncertain. Fractional flow reserve (FFR) has never been clinically validated in aortic stenosis. The study aim was to analyze the clinical outcome of FFR‐guided revascularization in patients undergoing transcatheter aortic valve implantation.Methods and ResultsPatients with severe aortic stenosis and coronary artery disease at coronary angiography were included in this retrospective analysis and divided in 2 groups: angiography guided (122/216; 56.5%) versus FFR‐guided revascularization (94/216; 43.5%). Patients were clinically followed up and evaluated for the occurrence of major adverse cardiac and cerebrovascular events at 2‐year follow‐up. Most lesions in the FFR group resulted negative according to the conventional 0.80 cutoff value (111/142; 78.2%) and were deferred. The FFR‐guided group showed a better major adverse cardiac and cerebrovascular event–free survival compared with the angio‐guided group (92.6% versus 82.0%; hazard ratio, 0.4; 95% CI, 0.2–1.0; P=0.035). Patients with deferred lesions based on FFR presented better outcome compared with patients who underwent angio‐guided percutaneous coronary intervention (91.4% versus 68.1%; hazard ratio, 0.3; 95% CI, 0.1–0.6; P=0.001).ConclusionsFFR guidance was associated with favorable outcome in this observational study in patients undergoing transcatheter aortic valve implantation. Randomized trials are needed to investigate the long‐term effects of FFR‐guided revascularization against angiographic guidance alone in patients with aortic stenosis.