Cerebral Blood Flow in Patients with Severe Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation

Vlastra, Wieneke; Nieuwkerk, Astrid C. van; Bronzwaer, Anne-Sophie G. T.; Versteeg, Adriaan; Bron, Esther E.; Niessen, Wiro J.; Mutsaerts, Henk‐Jan; Kim, Yu-Sok; Majoie, Charles B. L. M.; Biessels, Geert Jan; Nederveen, Aart J.; Daemen, M. J. A. P.; Osch, Matthias J.P. van; Baan, Jan; Piek, Jan J.; Lieshout, Johannes J. van; Delewi, Ronak

doi:10.1111/jgs.16882

Cited by 18 publications

(24 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 34 Recent studies show an immediate increase in cardiac output and cerebral blood flow following TAVR, suggesting a reserved or even decreased cerebral blood flow pre‐TAVR. 7 , 35 Our findings put forward the hypothesis that a chronic cerebral hypoperfusion pre‐TAVR may result into tolerance to an acute drop in IOH with a short duration during TAVR, a phenomenon called brain ischemic preconditioning. 36 , 37 , 38 Another factor that may explain our findings is the so‐called physiologic cerebral autoregulation, which alleviates a possible neurocognitive harmful effect of IOH.…”

Section: Discussionmentioning

confidence: 78%

Intraoperative hypotension and delirium among older adults undergoing transcatheter aortic valve replacement

Wesselink

Abawi

Kooistra

et al. 2021

J American Geriatrics Society

View full text Add to dashboard Cite

Background: Postoperative delirium (POD) is a frequently observed complication after transcatheter aortic valve replacement (TAVR). The effects of intraoperative hypotension (IOH) on POD occurrence are currently unclear.Methods: A retrospective observational cohort study of patients who underwent TAVR was conducted. We predefined IOH as area under the threshold (AUT) of five mean arterial blood pressures (MBP), varying from <100 to <60 mmHg. The AUT consisted of the combination of duration and depth under the MBP thresholds, expressed in mmHg*min. All MBP AUTs were computed based on the complete procedure, independent of procedural phase or duration. Results: This cohort included 675 patients who underwent TAVR under general anesthesia (n = 128, 19%) or procedural sedation (n = 547, 81%). Delirium occurred mostly during the first 2 days after TAVR, and was observed in n = 93 (14%) cases. Furthermore, 674, 672, 663, 630, and 518 patients had at least 1 min intraoperative MBP <100, <90, <80, <70, and <60 mmHg, respectively. Patients who developed POD had higher AUT based on all five MBP thresholds during TAVR. The penalized adjusted odds ratio varied between 1.08 (99% confidence interval [CI] 0.74-1.56) for the AUT based on MBP < 100 mmHg and OR 1.06 (99% CI 0.88-1.28) for the AUT based on MBP < 60 mmHg.Conclusions: Intraoperative hypotension is frequently observed during TAVR, but not independently associated with POD after TAVR. Other

show abstract

Section: Discussionmentioning

confidence: 78%

Intraoperative hypotension and delirium among older adults undergoing transcatheter aortic valve replacement

Wesselink

Abawi

Kooistra

et al. 2021

J American Geriatrics Society

View full text Add to dashboard Cite

show abstract

“…Previous reports have shown improvement in neurocognitive functions following successful stenting in patient with carotid stenosis and abnormal cerebral perfusion, using the same battery of tests as the present study [ 31 – 33 ]. An association between increase in cardiac output and increase in cerebral blood flow in 31 patients following TAVR was found by Vlastra et al [ 5 ]. Schoenenberger et al reported cognitive improvement in patients with pre-TAVR aortic valve area less than 0.6 cm 2 [ 12 ].…”

Section: Discussionmentioning

confidence: 84%

“…Transcatheter aortic valve replacement (TAVR) has become an increasingly preferred alternative to surgical aortic valve replacement [ 1 , 2 ], and its indication is rapidly expanding to population with low-to-intermediate surgical risk [ 3 , 4 ]. Restoration of cardiac output after TAVR may lead to subsequent improvement in cerebral perfusion [ 5 ] and results in cognitive improvement. However, patients undergoing TAVR are at risk for early cerebrovascular events immediately after, or in the first few hours, following the procedure [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Serial neurocognitive changes following transcatheter aortic valve replacement: comparison between low and intermediate-high risk groups

Kao

Yeh

et al. 2022

Aging

View full text Add to dashboard Cite

Background: Data comparing the neurocognitive trajectory between low and intermediate-high risk patients following transcatheter aortic valve replacement (TAVR) is never reported. Aims: To report serial neurocognitive changes up to 1 year post-TAVR in low and intermediate-high risk groups as well as overall cohort. Methods: Prospective neurological assessments (NIHSS and Barthel Index), global cognitive tests (MMSE and Alzheimer Disease Assessment Scale-Cognitive Subtest, ADAS-cog) and executive performances (Color Trail Test A and B and verbal fluency), were applied at baseline, 3 months and 1 year post-TAVR. Results: In overall cohort, persistent improvement to 1 year in MMSE, ADAS-cog, Color Trail Test A and B was found. According to the STS score, the study cohort was divided into low (<4%, N = 81) and intermediate-high (≧4%, N = 75) risk groups. The baseline neurologic and cognitive performance was significantly worse in intermediate-high risk group. Slight improvement on general neurological functions (Barthel index and proportion of NIHSS>0 patients) at 1 year could be observed only in intermediate-high risk group. In global cognitive assessments, improvement in MMSE and ADAS-cog at 1 year was found in both groups, but the proportion of cognitive improvement was more obvious in intermediate-high risk group. In Color Trail Tests and verbal fluency, significant and persistent improvement up to 1 year could be observed only in low risk group. Conclusions: TAVR was associated with persistent improvement in global cognitive function, as well as in attention and psychomotor processing speed, up to 1 year in overall cohort. However, improvement in tests for executive functions can only be seen in low risk group.

show abstract

“…The association with valvular heart disease and delirium is novel and might be explained by older age, which predisposes a person to valve diseases. Moreover, we attribute this finding to reduced cerebral blood perfusion secondary to valve diseases ( 37 ), which is linked to delirium ( 38 ). Previous studies report a positive association of delirium with heart failure ( 39 , 40 ).…”

Section: Discussionmentioning

confidence: 98%

Predisposing and Precipitating Risk Factors for Delirium in Elderly Patients Admitted to a Cardiology Ward: An Observational Cohort Study in 1,042 Patients

Zipser

Hildenbrand

Haubner

et al. 2021

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Aim: Although the risk factors for delirium in general medicine are well-established, their significance in cardiac diseases remains to be determined. Therefore, we evaluated the predisposing and precipitating risk factors in patients hospitalized with acute and chronic heart disease.Methods and Results: In this observational cohort study, 1,042 elderly patients (≥65 years) admitted to cardiology wards, 167 with and 875 without delirium, were included. The relevant sociodemographic and cardiac- and medical-related clusters were assessed by simple and multiple regression analyses and prediction models evaluating their association with delirium. The prevalence of delirium was 16.0%. The delirious patients were older (mean 80 vs. 76 years; p < 0.001) and more often institutionalized prior to admission (3.6 vs. 1.4%, p = 0.05), hospitalized twice as long (12 ± 10 days vs. 7 ± 7 days; p < 0.001), and discharged more often to nursing homes (4.8 vs. 0.6%, p < 0.001) or deceased (OR, 2.99; 95% CI, 1.53–5.85; p = 0.003). The most relevant risk factor was dementia (OR, 18.11; 95% CI, 5.77–56.83; p < 0.001), followed by history of stroke (OR, 6.61; 95% CI 1.35–32.44; p = 0.020), and pressure ulcers (OR, 3.62; 95% CI, 1.06–12.35; p = 0.040). The predicted probability for developing delirium was highest in patients with reduced mobility and institutionalization prior to admission (PP = 31.2%, p = 0.001). Of the cardiac diseases, only valvular heart disease (OR, 1.57; 95% CI, 1.01–2.44; p = 0.044) significantly predicted delirium. The patients undergoing cardiac interventions did not have higher rates of delirium (OR, 1.39; 95% CI 0.91–2.12; p = 0.124).Conclusion: In patients admitted to a cardiology ward, age-related functional and cognitive impairment, history of stroke, and pressure ulcers were the most relevant risk factors for delirium. With regards to specific cardiological factors, only valvular heart disease was associated with risk for delirium. Knowing these factors can help cardiologists to facilitate the early detection and management of delirium.

show abstract

Cerebral Blood Flow in Patients with Severe Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation

Cited by 18 publications

References 28 publications

Intraoperative hypotension and delirium among older adults undergoing transcatheter aortic valve replacement

Intraoperative hypotension and delirium among older adults undergoing transcatheter aortic valve replacement

Serial neurocognitive changes following transcatheter aortic valve replacement: comparison between low and intermediate-high risk groups

Predisposing and Precipitating Risk Factors for Delirium in Elderly Patients Admitted to a Cardiology Ward: An Observational Cohort Study in 1,042 Patients

Contact Info

Product

Resources

About