Cognitive function after transapical aortic valve implantation: a single-centre study with 3-month follow-up

Knipp, Stephan; Kahlert, Philipp; Jokisch, Daniel; Schlamann, Marc; Wendt, Daniel; Weimar, Christian; Jakob, Heinz; Thielmann, Matthias

doi:10.1093/icvts/ivs461

Cited by 56 publications

(54 citation statements)

References 22 publications

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“…Furthermore, cognitive performance was altered only mildly compared with the surgical valve replacement. 34 In parallel with our data, in the 3 studies that included the assessment of cognitive function, a correlation between cerebral embolism and cognitive function was not found. [35][36][37] Although these events are not unequivocally accepted as a contributing mechanism of early CD, 14 various protective approaches aim to reduce embolic burden during cardiovascular procedures.…”

Section: Cerebral Embolismsupporting

confidence: 86%

Cognitive Trajectory After Transcatheter Aortic Valve Implantation

Ghanem

Kocurek

Sinning

et al. 2013

Circ: Cardiovascular Interventions

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Background-Transcatheter aortic valve implantation (TAVI) is known to be associated with silent cerebral injury, which could contribute to cognitive impairment. Considering its increasing use, thorough longitudinal investigation of cognitive trajectory after TAVI is pivotal. Methods and Results-Repeatable battery for the assessment of neuropsychological status was performed before (E1), 3 days (E2), 3 months (E3), 1 (E4) year, and 2 years (E5) after TAVI. Baseline characteristics, procedural data, imaging parameters of brain injury (diffusion-weighted MRI), and the use of conceivable neuroprotective approaches were investigated for their effect on cognitive function. Cognitive performance was investigated in 111 patients (mean log EuroSCORE, 30±13%). Global cognitive function (repeatable battery for the assessment of neuropsychological status total score) increased transiently at E2 (P=0.02) and was comparable with baseline levels at E3, E4, and E5. Six patients (5.4%) demonstrated early cognitive decline. Persistence and late onset were seen infrequently (n=3, 2.7% and n=4, 3.6%, respectively). Hence, early cognitive decline was ruled out in 105 patients (94.6%), and a majority of patients (91%) demonstrated sustained cognitive performance throughout all investigated time points. Interestingly, only patient age (P=0.012), but not prior cerebrovascular events, cognitive status, direct TAVI, cerebral embolism in diffusion-weighted MRI, or the use of a cerebral embolic protection device was found to be independently associated with cognitive decline, linking higher age to cognitive impairment along the first 2 years after TAVI. Conclusions-Long-term cognitive performance was preserved in the great majority (91%) of patients throughout the first 2 years after TAVI, despite the high intrinsic risk for cognitive deterioration. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00883285.(Circ Cardiovasc Interv. 2013;6:615-624.)Key Words: cognition ◼ dementia ◼ injury ◼ intracranial embolism ◼ mild cognitive impairment ◼ stroke ◼ TAVR

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Section: Cerebral Embolismsupporting

confidence: 86%

Cognitive Trajectory After Transcatheter Aortic Valve Implantation

Ghanem

Kocurek

Sinning

et al. 2013

Circ: Cardiovascular Interventions

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“…However, several studies have shown that 58%-77% of patients undergoing TAVR have small, silent cerebral infarctions detectable on magnetic resonance imaging with an incidence significantly higher than in patients undergoing SAVR. [83][84][85][86] At this time, it seems that these silent infarctions do not have negative impact on cognitive function or post-procedural health status. 83,86 In contrast, if a clinically apparent neurologic event has occurred, mortality is increased.…”

Section: Neurologic Eventsmentioning

confidence: 87%

“…[83][84][85][86] At this time, it seems that these silent infarctions do not have negative impact on cognitive function or post-procedural health status. 83,86 In contrast, if a clinically apparent neurologic event has occurred, mortality is increased. 20,34,50,63 In part A of the PARTNER Trial, the 30-day prevalence of neurologic events was significantly higher after TAVR than after SAVR (5.5% vs 2.4%, P = 0.04), whereas the rate of major stroke showed a tendency toward higher prevalence after TAVR but did not reach significance (3.8% vs 2.4%, P = 0.2).…”

Section: Neurologic Eventsmentioning

confidence: 87%

Transcatheter aortic valve replacement

Damberg¹,

Benstoem²,

Autschbach³

et al. 2013

RRCC

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Abstract:The standard treatment for symptomatic severe aortic valve stenosis is surgical aortic valve replacement. Over the last decade, transcatheter aortic valve replacement has emerged as an option for patients judged inoperable. It might also constitute an alternative for high-risk patients, even though which patients might benefit from this approach is still being discussed and remains controversial. Transcatheter heart valve replacement is a rapidly spreading technology. However, a number of problems still need to be addressed, such as paravalvular regurgitation, stroke rate, and postoperative conduction disturbances. Further, the durability of transcatheter heart valves remains unclear. Randomized clinical trials and long-term follow-up will help define the role of transcatheter heart valve replacement in aortic stenosis therapy.

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“…In the short postprocedural period (≤3 months), no direct relation could be demonstrated between those infarcts and cognitive dysfunction 38,39 and health-related quality of life. 35 In the longer term follow-up (≤2 years), the risk of cognitive dysfunction (which was generally low) was determined by age, but not by the burden of brain infarcts.…”

Section: Subclinical Embolization and Silent Brain Infarctsmentioning

confidence: 94%

“…32 Using cerebral diffusion-weighted magnetic resonance imaging, the rate of silent brain infarcts after TAVI ranged from 68% to 91.5% [33][34][35][36][37] compared with <50% in SAVR patients. 33,38 The clinical correlates of these infarcts are not clearly known.…”

Section: Subclinical Embolization and Silent Brain Infarctsmentioning

confidence: 99%

Transcatheter Aortic Valve Implantation in Lower-Risk Patients With Aortic Stenosis

Abdelghani

Serruys

2016

Circ: Cardiovascular Interventions

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Abstract-Transcatheter aortic valve implantation underwent progressive improvements until it became the default therapy for inoperable patients, and a recommended therapy in high-risk operable patients with symptomatic severe aortic stenosis. In the lower-risk patient strata, a currently costly therapy that still has important complications with questionable durability is competing with the established effective and still-improving surgical replacement. This report tries to weigh the clinical evidence, the recent technical improvements, the durability, and the cost-effectiveness claims supporting the adoption of transcatheter aortic valve implantation in intermediate-low risk patients. The importance of appropriate patients' risk stratification and a more comprehensive approach to estimate that risk are also emphasized in the present report. (Circ Cardiovasc Interv. 2016;9:e002944.

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Cognitive function after transapical aortic valve implantation: a single-centre study with 3-month follow-up

Abstract: Cognitive function was only mildly impaired after TA-TAVI when compared with a marked, albeit transient, decline after surgical AVR. Focal embolic brain injury tended to occur more frequently after TA-TAVI, but this was not related to cognitive decline during the 3-month follow-up.

Cited by 56 publications

References 22 publications

Cognitive Trajectory After Transcatheter Aortic Valve Implantation

Cognitive Trajectory After Transcatheter Aortic Valve Implantation

Transcatheter aortic valve replacement

Transcatheter Aortic Valve Implantation in Lower-Risk Patients With Aortic Stenosis

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