Aiman Alassar1, Gopal Soppa1, Mark Edsell1, Philip Rich2, David Roy1, Irina Chis Ster1, Ruth Joyce1, Oswaldo Valencia1, Thomas Barrick2, Franklyn Howe2, Neil Moat3, Robin Morris4, Hugh S Markus5, Marjan Jahangiri6. 1. Department of Cardiac Surgery, Cardiology and Anesthesia, St. George's Hospital, London, United Kingdom. 2. Department of Neuroradiology, St. George's Hospital, London, United Kingdom. 3. Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom. 4. Department of Psychology, King's College Hospital, London, United Kingdom. 5. Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom. 6. Department of Cardiac Surgery, Cardiology and Anesthesia, St. George's Hospital, London, United Kingdom. Electronic address: marjan.jahangiri@stgeorges.nhs.uk.
Abstract
BACKGROUND: The most likely mechanisms of neurologic injury after transcatheter aortic valve implantation (TAVI) and aortic valve replacement (AVR) are cerebral embolization and hypoperfusion. We set out to determine potential mechanisms of neurologic injury after TAVI compared with AVR. METHODS: One hundred twenty-seven consecutive high-risk patients with severe aortic stenosis (AS) who underwent TAVI (n = 85) or AVR (n = 42) were studied. Transcranial Doppler ultrasound (TCD), cerebral oximetry, diffusion-weighted magnetic resonance imaging (DW-MRI) (before, 6 days, and 3 months after procedure), and neurocognitive assessment before and at 3 months were performed. RESULTS: Neurologic injury was not significantly different between TAVI and AVR at 1 (1.1% vs 2.2%, p = 0.25) and 3 months (4.7% vs 2.2%, p = 1). At 3 months, overall cognitive score was higher in AVR compared with TAVI when adjusted for baseline score; the estimated difference between groups was 0.63 (95% confidence interval 0.87% to 1.17%; p = 0.02). Cerebral embolic load was 212 (123 to 344) during AVR and 134 (76 to 244) during TAVI (p = 0.07). Cerebral oxygen desaturation during AVR (7.56 ± 2.16) was higher compared with TAVI (5.93 ± 2.47) (p < 0.01). Ischemic lesions measured by DW-MRI occurred in 76% of TAVI and 71% of AVR patients at 6 days (p = 0.69) and 63% and 39% at 3 months (p = 0.11). No significant association was found between cerebral emboli, cerebral oxygen desaturation, brain ischemic lesions, and general cognitive score. CONCLUSIONS: At 3 months follow-up, overall cognitive score was higher in AVR compared with TAVI, adjusted for baseline score. However, there was no difference in cerebral embolic load, ischemic lesions, and oxygen desaturation.
BACKGROUND: The most likely mechanisms of neurologic injury after transcatheter aortic valve implantation (TAVI) and aortic valve replacement (AVR) are cerebral embolization and hypoperfusion. We set out to determine potential mechanisms of neurologic injury after TAVI compared with AVR. METHODS: One hundred twenty-seven consecutive high-risk patients with severe aortic stenosis (AS) who underwent TAVI (n = 85) or AVR (n = 42) were studied. Transcranial Doppler ultrasound (TCD), cerebral oximetry, diffusion-weighted magnetic resonance imaging (DW-MRI) (before, 6 days, and 3 months after procedure), and neurocognitive assessment before and at 3 months were performed. RESULTS:Neurologic injury was not significantly different between TAVI and AVR at 1 (1.1% vs 2.2%, p = 0.25) and 3 months (4.7% vs 2.2%, p = 1). At 3 months, overall cognitive score was higher in AVR compared with TAVI when adjusted for baseline score; the estimated difference between groups was 0.63 (95% confidence interval 0.87% to 1.17%; p = 0.02). Cerebral embolic load was 212 (123 to 344) during AVR and 134 (76 to 244) during TAVI (p = 0.07). Cerebral oxygen desaturation during AVR (7.56 ± 2.16) was higher compared with TAVI (5.93 ± 2.47) (p < 0.01). Ischemic lesions measured by DW-MRI occurred in 76% of TAVI and 71% of AVR patients at 6 days (p = 0.69) and 63% and 39% at 3 months (p = 0.11). No significant association was found between cerebral emboli, cerebral oxygen desaturation, brain ischemic lesions, and general cognitive score. CONCLUSIONS: At 3 months follow-up, overall cognitive score was higher in AVR compared with TAVI, adjusted for baseline score. However, there was no difference in cerebral embolic load, ischemic lesions, and oxygen desaturation.
Authors: Michael J Mack; Michael A Acker; Annetine C Gelijns; Jessica R Overbey; Michael K Parides; Jeffrey N Browndyke; Mark A Groh; Alan J Moskowitz; Neal O Jeffries; Gorav Ailawadi; Vinod H Thourani; Ellen G Moquete; Alexander Iribarne; Pierre Voisine; Louis P Perrault; Michael E Bowdish; Michel Bilello; Christos Davatzikos; Ralph F Mangusan; Rachelle A Winkle; Peter K Smith; Robert E Michler; Marissa A Miller; Karen L O'Sullivan; Wendy C Taddei-Peters; Eric A Rose; Richard D Weisel; Karen L Furie; Emilia Bagiella; Claudia Scala Moy; Patrick T O'Gara; Steven R Messé Journal: JAMA Date: 2017-08-08 Impact factor: 56.272
Authors: Pál Maurovich-Horvat; Béla Merkely; Andrea Varga; Gyula Gyebnár; Ferenc Imre Suhai; Anikó Ilona Nagy; Lajos Rudolf Kozák; Csenge Ágnes Póka; Mirjam Franciska Turáni; Sarolta Borzsák; Astrid Apor; Andrea Bartykowszki; Bálint Szilveszter; Márton Kolossváry Journal: Neuroradiology Date: 2022-08-01 Impact factor: 2.995