Intraoperative Cerebral Perfusion Disturbances During Transcatheter Aortic Valve Replacement

Fanning, Jonathon P.; Walters, D.; Wesley, Allan J.; Anstey, Chris; Huth, Samuel; Bellapart, Judith; Collard, Caroline; Rapchuk, Ivan L.; Natani, Sarvesh; Savage, M.

doi:10.1016/j.athoracsur.2017.04.053

Cited by 14 publications

(19 citation statements)

References 25 publications

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“…Seven studies reported IHPOD according to the CAM, for a total of 682 patients (Figure ) . The pooled estimate rate of CAM‐defined IHPOD was 13.5% (95% CI=4.9–22.1%), with evidence of high interstudy heterogeneity (Q = 151; I = 96%; p heterogeneity < .001).…”

Section: Resultsmentioning

confidence: 77%

“…The majority of participants included in our meta‐analysis were derived from 2 large prospective registries, with the lack of information regarding delirium diagnostic criteria and timing of the delirium screening . Interestingly, while these 2 large studies reported lower incidence of IHPOD after TAVR (e.g., 3.8% and 4.6%), small studies included in our analysis report higher incidence of IHPOD after TAVR . Several participant‐ and procedural‐related factors, including age at admission, comorbid condition, TAVR access, and hospital complication rate, could explain the differences in the incidence of IHPOD between these studies.…”

Section: Discussionmentioning

confidence: 89%

“…Seven studies reported IHPOD according to the CAM, for a total of 682 patients ( Figure 3). 17,24,28,30,32,34,41 The pooled estimate rate of CAM-defined IHPOD was 13.5% (95% CI=4.9-22.1%), with evidence of high interstudy heterogeneity (Q = 151; I 2 = 96%; p heterogeneity < .001). Thirteen studies (total 20,537 participants) clearly reported the occurrence of IHPOD in individuals undergoing TF-TAVR.…”

Section: Resultsmentioning

confidence: 99%

“…When inclusion and exclusion criteria were applied, 31 publications remained for assessment. 6,8,9,11,17, Most included studies were observational (14 prospective, 6,17,23,[26][27][28][29][30]33,35,37,41,44,47 6 propensity matched, 22,24,25,36,40,42 10 retrospective 8,9,11,31,32,34,38,43,45,46 ), with only one randomized controlled trial. 39 Differences in the differential diagnosis between POD and other comparable cognitive disorders, including dementia, depression, and schizophrenia, are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…29,45 Interestingly, while these 2 large studies reported lower incidence of IHPOD after TAVR (e.g., 3.8% and 4.6%), small studies included in our analysis report higher incidence of IHPOD after TAVR. 6,8,9,11,17,[22][23][24][25][26][27][28][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]46,47 Several participant-and procedural-related factors, including age at admission, comorbid condition, TAVR access, and hospital complication rate, could explain the differences in the incidence of IHPOD between these studies. Larger studies are needed to identify clinical and procedural predictors of change in cognitive status early after TAVR, and to evaluate nonpharmacological strategies to reduce the incidence of IHPOD after TAVR.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative Delirium in Individuals Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta‐Analysis

Abawi

Pagnesi

Agostoni

et al. 2018

J American Geriatrics Society

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Objectives To evaluate the incidence of in‐hospital postoperative delirium (IHPOD) after transcatheter aortic valve replacement (TAVR). Design Systematic review and meta‐analysis. Setting Elective procedures Participants Individuals undergoing TAVR. Measurements A literature search was conducted in PubMed, Embase, BioMedCentral, Google Scholar, and the Cochrane Central Register of Controlled Trials (up to December 2017). All observational studies reporting the incidence of IHPOD after TAVR (sample size > 25) were included in our meta‐analysis. The reported incidence rates were weighted to obtain a pooled estimate rate with 95% confidence interval (CI). Results Of 96 potentially relevant articles, 31 with a total of 32,389 individuals who underwent TAVR were included in the meta‐analysis. The crude incidence of IHPOD after TAVR ranged from 0% to 44.6% in included studies, with a pooled estimate rate of 8.1% (95% CI=6.7–9.4%); heterogeneity was high (Q = 449; I = 93%; pheterogeneity < .001). The pooled estimate rate of IHPOD was 7.2% (95% CI=5.4–9.1%) after transfemoral (TF) TAVR and 21.4% (95% CI=10.3–32.5%) after non‐TF TAVR. Conclusion Delirium occurs frequently after TAVR and is more common after non‐TF than TF procedures. Recommendations are made with the aim of standardizing future research to reduce heterogeneity between studies on this important healthcare problem. J Am Geriatr Soc 66:2417–2424, 2018.

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Section: Resultsmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Postoperative Delirium in Individuals Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta‐Analysis

Abawi

Pagnesi

Agostoni

et al. 2018

J American Geriatrics Society

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Neuron-Specific Enolase and Matrix Metalloproteinase 9 Signal Perioperative Silent Brain Infarction During or After Transcatheter Aortic Valve Implantation

Fanning

Hoe

Passmore

et al. 2019

The American Journal of Cardiology

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Magnetic resonance imaging (MRI) studies have consistently identified a high incidence of silent brain infarction (SBI) following cardiac intervention. The frequent occurrence, objective measurement and clinical sequelae of SBI have seen interest in their detection for both research and clinical purposes.However, MRI is expensive, time-consuming, unsafe in acutely-ill patients, and not always available, limiting its use as a routine screening tool. For this purpose, a blood biomarker of SBI would be the 'Holy Grail'. By performing targeted profiling of serologic biomarkers this study aimed to assess their potential as screening tools for perioperative SBI. This is a nested case-control study of 20 prospectively recruited patients undergoing transcatheter aortic valve implantation under general anesthesia. Clinical and diffusion-weighted MRI assessments were performed at baseline and on day 3 post-procedure to identify the presence (cases) or absence (controls) of new SBI. Blood was collected at baseline and 24, 48 and 72 hours post-procedure and analyzed for S100 calcium-binding protein B, neuron specific enolase (NSE), matrix metalloproteinase 9 (MMP 9) and glial fibrillary acidic protein. Best-fit polynomial curves using a smoothing model were generated for each biomarker and inferential testing at a pre-defined 24-hour post-procedure timepoint detected a significant difference for MMP 9 (72,435; SEM: 25,030; P = 0.027). Longitudinal regression revealed a statistically significant case-control difference for both NSE (mean: 10,747; SEM: 3,114) and MMP 9 (63,842; SEM: 16,173). In conclusion, NSE and MMP 9 are present in higher levels following SBI and warrant further investigation for their utility as screening tools.

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Meta-Analysis of Prevalence and Risk Factors for Cognitive Decline and Improvement After Transcatheter Aortic Valve Implantation

Ghezzi

Ross

Davis

et al. 2020

The American Journal of Cardiology

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Changes to cognition, both decline and improvement, are commonly reported after transcatheter aortic valve implantation (TAVI). However, previous systematic reviews and metaanalyses have missed these subgroups by assessing whole-group-averages for cognitive outcomes. We sought to pool estimates to identify the prevalence of cognitive decline and improvement after TAVI, as well as associated factors for these outcomes. A systematic review identified 15 articles appropriate for meta-analysis. When robust cognitive change definitions were employed, the pooled prevalence of incident cognitive impairment up to 1-, 1 to 6-, and ≥6-months post-TAVI was 7%, 14%, and 12%, respectively. For cognitive improvement, the prevalence from 1 to 6 months and ≥6 months after TAVI was estimated to be 19% and 11%, respectively. Two factors were associated with these cognitive outcomes: (1) using a cerebral embolic protection device was associated with decreased prevalence of cognitive decline up to 1-week post-TAVI; (2) baseline cognitive impairment had a large association with post-TAVI cognitive improvement. In conclusion, cognitive decline and cognitive improvement are experienced by approximately 7% to 19% of patients after TAVI, respectively. Those with the lowest cognitive performance pre-TAVI appear to have the most to gain in terms of cognitive improvement post-TAVI. Identifying further predictive factors for cognitive decline and improvement post-TAVI will facilitate a personalizedmedicine approach for cognitive care and prognosis.

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Intraoperative Cerebral Perfusion Disturbances During Transcatheter Aortic Valve Replacement

Abstract: Cerebral oximetry reacted promptly to rapid ventricular pacing with significant desaturation and hyperemia a common occurrence. However, no association between this intraoperative insult and objective neurologic injury was detected.

Cited by 14 publications

References 25 publications

Postoperative Delirium in Individuals Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta‐Analysis

Postoperative Delirium in Individuals Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta‐Analysis

Neuron-Specific Enolase and Matrix Metalloproteinase 9 Signal Perioperative Silent Brain Infarction During or After Transcatheter Aortic Valve Implantation

Meta-Analysis of Prevalence and Risk Factors for Cognitive Decline and Improvement After Transcatheter Aortic Valve Implantation

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