Imaging and Functional Testing to Assess Clinical and Subclinical Neurological Events After Transcatheter or Surgical Aortic Valve Replacement

Spaziano, Marco; Francese, Dominic P.; Leon, Martin B.; Généreux, Philippe

doi:10.1016/j.jacc.2014.07.986

Cited by 32 publications

(7 citation statements)

References 56 publications

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“…Also, two TEVAR patients are included; however, their postoperative samples were excluded so that potential effects of the ECC would be similar in all analyzed samples. Also, there is a possibility that subclinical strokes were missed [ 29 ], as neuroimaging was not performed routinely, only upon clinical suspicion.…”

Section: Discussionmentioning

confidence: 99%

Protein Profiling in Serum and Cerebrospinal Fluid Following Complex Surgery on the Thoracic Aorta Identifies Biological Markers of Neurologic Injury

Lindblom

Shen

Axén

et al. 2018

J. of Cardiovasc. Trans. Res.

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Surgery on the arch or descending aorta is associated with significant risk of neurological complications. As a consequence of intubation and sedation, early neurologic injury may remain unnoticed. Biomarkers to aid in the initial diagnostics could prove of great value as immediate intervention is critical. Twenty-three patients operated in the thoracic aorta with significant risk of perioperative neurological injury were included. Cerebrospinal fluid (CSF) and serum were obtained preoperatively and in the first and second postoperative days and assessed with a panel of 92 neurological-related proteins. Three patients suffered spinal cord injury (SCI), eight delirium, and nine hallucinations. There were markers in both serum and CSF that differed between the affected and non-affected patients (SCI; IL6, GFAP, CSPG4, delirium; TR4, EZH2, hallucinations; NF1). The study identifies markers in serum and CSF that reflect the occurrence of neurologic insults following aortic surgery, which may aid in the care of these patients.Electronic supplementary materialThe online version of this article (10.1007/s12265-018-9835-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Protein Profiling in Serum and Cerebrospinal Fluid Following Complex Surgery on the Thoracic Aorta Identifies Biological Markers of Neurologic Injury

Lindblom

Shen

Axén

et al. 2018

J. of Cardiovasc. Trans. Res.

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“…27 At present, pre-and postprocedure neurocognitive testing is not routinely required in clinical trials of MV therapies, although analysis of neurocognitive data may be a worthwhile secondary endpoint for future analysis. 28 Finally, it has become increasingly recognized that, in many cases, cerebral infarction (as evidenced by new abnormalities detected by diffusion-weighted magnetic resonance imaging) may occur during surgical and interventional procedures, but be clinically silent. 29 -31 As the relationship between these asymptomatic defects and the development of declining neurocognitive function is uncertain, 32 -35 in the absence of clinical symptoms or signs of cerebral infarction, their occurrence should not currently be included in the primary endpoint of stroke in trials investigating novel transcatheter devices for MR.…”

Section: Neurological Eventsmentioning

confidence: 99%

Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: part 2: endpoint definitions

et al. 2015

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Mitral regurgitation (MR) is one of the most prevalent valve disorders and has numerous aetiologies, including primary (organic) MR, due to underlying degenerative/structural mitral valve (MV) pathology, and secondary (functional) MR, which is principally caused by global or regional left ventricular remodelling and/or severe left atrial dilation. Diagnosis and optimal management of MR requires integration of valve disease and heart failure specialists, MV cardiac surgeons, interventional cardiologists with expertise in structural heart disease, and imaging experts. The introduction of trans- catheter MV therapies has highlighted the need for a consensus approach to pragmatic clinical trial design and uniform endpoint definitions to evaluate outcomes in patients with MR. The Mitral Valve Academic Research Consortium is a collaboration between leading academic research organizations and physician-scientists specializing in MV disease from the United States and Europe. Three in-person meetings were held in Virginia and New York during which 44 heart failure, valve, and imaging experts, MV surgeons and interventional cardiologists, clinical trial specialists and statisticians, and representatives from the U.S. Food and Drug Administration considered all aspects of MV pathophysiology, prognosis, and therapies, culminating in a 2-part document describing consensus recommendations for clinical trial design (Part 1) and endpoint definitions (Part 2) to guide evaluation of transcatheter and surgical therapies for MR. The adoption of these recommendations will afford robustness and consistency in the comparative effectiveness evaluation of new devices and approaches to treat MR. These principles may be useful for regulatory assessment of new transcatheter MV devices, as well as for monitoring local and regional outcomes to guide quality improvement initiatives.

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“…although only a minority of patients develop a focal neurological deficit, they have been shown to negatively affect cognitive function and increase the risk of future stroke [64][65][66][67][68]. Aiming at reducing the load of emboli reaching cerebral vascular territory, embolic protection devices were developed.…”

Section: Aortic Valve Calcification and Strokementioning

confidence: 99%

How valvular calcification can affect the outcomes of transcatheter aortic valve implantation

Pio

Bax

Delgado

2020

Expert Review of Medical Devices

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Introduction: In transcatheter aortic valve implantation (TAVI), assessment of aortic valve calcification is not as standardized as aortic annulus measurement. Aortic valve calcification is important for stable anchoring of the prosthesis to the aortic annulus. However, excessive aortic valve calcification is related to procedural complications. Areas covered: This review covers the methods to assess aortic valve calcification and the implications of aortic valve calcium burden for TAVI outcomes. We performed a systematic review of the literature in Pubmed and secondary sources. Furthermore, future perspectives on how to integrate aortic valve calcification assessment in the management of patients with aortic stenosis is discussed. Expert opinion: Thorough assessment of the aortic valve and aortic root components including aortic valve calcification is key in the planning of TAVI. Aortic valve calcification load, location and extension are important contributors to paravalvular regurgitation. Asymmetric calcification burden with greater calcification of the left-coronary cusp related to higher need of permanent pacemaker implantation. Patients with moderate and severe left ventricular outflow tract/subannular calcification are more susceptible to aortic annular rupture. Periprocedural dislodgement of calcium form cusps and commissures is one of the main reasons of coronary artery ostial occlusion during transcatheter aortic valve implantation.

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Imaging and Functional Testing to Assess Clinical and Subclinical Neurological Events After Transcatheter or Surgical Aortic Valve Replacement

Cited by 32 publications

References 56 publications

Protein Profiling in Serum and Cerebrospinal Fluid Following Complex Surgery on the Thoracic Aorta Identifies Biological Markers of Neurologic Injury

Protein Profiling in Serum and Cerebrospinal Fluid Following Complex Surgery on the Thoracic Aorta Identifies Biological Markers of Neurologic Injury

Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: part 2: endpoint definitions

How valvular calcification can affect the outcomes of transcatheter aortic valve implantation

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