OBJECTIVES: This study assessed the rate of periprocedural embolic ischemic brain injury during transapical aortic valve replacement in 25 consecutive patients. BACKGROUND: Transcatheter aortic valve implantation is rapidly being established as a new therapeutic approach for aortic valve stenosis. Although initial clinical results are promising, it is unknown whether mobilization and embolization of calcified particles may lead to cerebral ischemia. METHODS: Twenty-five consecutive patients (10 men, 15 women, mean age: 81 ± 5 years, mean log EuroSCORE [European System for Cardiac Operative Risk Evaluation]: 32 ± 10%) scheduled for transapical aortic valve implantation were included. All patients received a baseline cerebral magnetic resonance imaging scan. The scan was repeated approximately 6 days after valve implantation. The magnetic resonance imaging studies included axial diffusion-weighted, T(2)-weighted, fluid attenuated inversion recovery-weighted, and T(2) gradient echo sequences. Standardized assessment of the neurologic status was performed before aortic valve replacement and post-operatively. RESULTS: Transapical aortic valve implantation was successfully performed in all patients. In 17 patients (68%), new cerebral lesions could be detected, whereas 8 patients showed no new cerebral insults. The pattern of distribution and morphology were typical of embolic origin. Despite the high incidence of morphologically detectable lesions, only 5 patients showed clinical neurologic alterations. Out of these patients, only 1 suffered from a permanent stroke. CONCLUSIONS: New embolic ischemic cerebral insults are detected in 68% of patients after transapical valve implantation. Clinical symptoms are rare and usually transitory. Larger trials will need to establish the clinical significance of asymptomatic ischemic lesions as well as the rate of ischemic events in patients undergoing transfemoral valve replacement.
OBJECTIVES: This study assessed the rate of periprocedural embolic ischemic brain injury during transapical aortic valve replacement in 25 consecutive patients. BACKGROUND: Transcatheter aortic valve implantation is rapidly being established as a new therapeutic approach for aortic valve stenosis. Although initial clinical results are promising, it is unknown whether mobilization and embolization of calcified particles may lead to cerebral ischemia. METHODS: Twenty-five consecutive patients (10 men, 15 women, mean age: 81 ± 5 years, mean log EuroSCORE [European System for Cardiac Operative Risk Evaluation]: 32 ± 10%) scheduled for transapical aortic valve implantation were included. All patients received a baseline cerebral magnetic resonance imaging scan. The scan was repeated approximately 6 days after valve implantation. The magnetic resonance imaging studies included axial diffusion-weighted, T(2)-weighted, fluid attenuated inversion recovery-weighted, and T(2) gradient echo sequences. Standardized assessment of the neurologic status was performed before aortic valve replacement and post-operatively. RESULTS: Transapical aortic valve implantation was successfully performed in all patients. In 17 patients (68%), new cerebral lesions could be detected, whereas 8 patients showed no new cerebral insults. The pattern of distribution and morphology were typical of embolic origin. Despite the high incidence of morphologically detectable lesions, only 5 patients showed clinical neurologic alterations. Out of these patients, only 1 suffered from a permanent stroke. CONCLUSIONS: New embolic ischemic cerebral insults are detected in 68% of patients after transapical valve implantation. Clinical symptoms are rare and usually transitory. Larger trials will need to establish the clinical significance of asymptomatic ischemic lesions as well as the rate of ischemic events in patients undergoing transfemoral valve replacement.
Authors: Vasco da Gama Ribeiro; Luis Vouga; Alan Markowitz; Hiram G Bezerra; Pedro Braga; Muhammad Ansari; Daniel Leite; Joao Rocha; Monica Carvalho; Daniel I Simon; Marco A Costa Journal: Int J Cardiovasc Imaging Date: 2011-08-31 Impact factor: 2.357
Authors: Stephan C Knipp; Philipp Kahlert; Daniel Jokisch; Marc Schlamann; Daniel Wendt; Christian Weimar; Heinz Jakob; Matthias Thielmann Journal: Interact Cardiovasc Thorac Surg Date: 2012-11-11
Authors: Hector Cubero-Gallego; Isaac Pascual; José Rozado; Ana Ayesta; Daniel Hernandez-Vaquero; Rocio Diaz; Alberto Alperi; Pablo Avanzas; Cesar Moris Journal: Ann Transl Med Date: 2019-10
Authors: Mariam Samim; Jeroen Hendrikse; H Bart van der Worp; Pierfrancesco Agostoni; Freek Nijhoff; Pieter A Doevendans; Pieter R Stella Journal: Clin Res Cardiol Date: 2015-01-18 Impact factor: 5.460
Authors: Mariëlla E C Hassell; Robin Nijveldt; Yvo B W Roos; Charles B L Majoie; Martial Hamon; Jan J Piek; Ronak Delewi Journal: Nat Rev Cardiol Date: 2013-10-29 Impact factor: 32.419