Neurologic Complications of Unprotected Transcatheter Aortic Valve Implantation (from the Neuro-TAVI Trial)

Lansky, Alexandra J.; Brown, David L.; Peña, Constantino; Pietras, Cody; Parise, Helen; Ng, Vivian G.; Meller, Stephanie; Abrams, Kevin; Cleman, Michael; Margolis, Pauliina; Petrossian, George; Brickman, Adam M.; Vörös, Szilárd; Moses, Jeffrey W.; Forrest, John K.

doi:10.1016/j.amjcard.2016.08.013

Cited by 75 publications

(56 citation statements)

References 23 publications

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“…The incidence of DW‐MRI new brain lesions (NBL) after TAVR was 73% in the NV and 51% in the VIV groups ( p = .005). These rates, although lower than previously reported, 2 remain impressively high. Although most NBL are clinically silent (stroke rate was 0.5 vs. 2.4%, respectively), they can actually be associated with slight memory deficits or behavioral alterations.…”

contrasting

confidence: 76%

The first love, you never forget. The last heart valve, you might remember better than the first

Aranzulla

Musumeci

2020

Cathet Cardio Intervent

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Key Points Valve‐in‐valve (VIV) transcatheter aortic valve replacement (TAVR) does not increase cerebrovascular risk compared with TAVR in native aortic valves; the only predictors of new brain lesions were age and postdilatation. Wise choice of the biological valve at the time of surgical aortic replacement, routine use of cerebral protection devices, and new therapeutic paths may be important. Larger studies are needed, hopefully with systematic postdilatation or bioprosthetic valve fracture in cases of residual high transvalvular gradients after VIV TAVR.

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contrasting

confidence: 76%

The first love, you never forget. The last heart valve, you might remember better than the first

Aranzulla

Musumeci

2020

Cathet Cardio Intervent

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“…The use of cerebral embolic protection devices has been associated with less‐extensive microembolic lesion occurrence and higher cognitive scores, which may have influenced outcomes. Studies using cerebral embolic protection were not excluded in these analyses because none of the included studies reported a significant overall treatment effect of cerebral protection on neurological findings or cognitive outcomes . Cognitive function has been related to vascular health, and postoperative cognitive dysfunction has been related to valvular procedures .…”

Section: Discussion and Limitationsmentioning

confidence: 99%

“…Two studies reported death as a reason for loss to follow-up, 15,43 and three studies did not specify whether dropouts were because of major adverse cardiac and cerebrovascular events. 17,41,42 In one study, it was not clear whether cognitive test scores at baseline were carried forward in participants who had died before follow-up cognitive assessment. 19 This may introduce a potential bias in the post-TAVI cognitive performance data because the number of participants with worsening cognition may have been underrepresented after TAVI because of competing risks including death and debilitating strokes.…”

Section: Discussion and Limitationsmentioning

confidence: 99%

Cognitive Outcomes After Transcatheter Aortic Valve Implantation: A Metaanalysis

Khan

Herrmann

Gallagher

et al. 2017

J American Geriatrics Society

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“…Clinical stroke rates can be as low as 1.6% in some TAVR series; however, as per the recent American Heart Association/American Stroke Association (AHA/ASA) guidelines, radiographic evidence of cerebral infarction can be detected in the majority of patients undergoing TAVR 12. In conjunction with expanding indications in intermediate-risk patients and the possible inclusion of low-risk patients, optimising TAVR outcomes has been of increased focus using cerebral embolic protection devices.…”

Section: Cerebrovascular Embolic Protectionmentioning

confidence: 99%

Clinical trials of transcatheter aortic valve replacement

Al‐Azizi

Hamandi

2019

Heart

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Transcatheter aortic valve replacement(TAVR) has emerged as an effective treatment option in patients with severe aortic stenosis, in large part due to a robust evidence base generated by a series of randomised controlled trials (RCTs). During the past decade more than 15 000 patients have been randomised worldwide in nine clinical trials, mostly for regulatory approval in the USA, making it one of the most carefully scrutinised medical devices at the time of introduction into clinical practice. Initial trials were performed in inoperable or extreme risk patients compared to medical therapy and demonstrated superiority. Subsequent RCTs compared TAVR to surgical aortic valve replacement in high and intermediate surgical risk patients and TAVR was found to be non-inferior in all studies. RCTs of low surgical risk patients have completed enrolment and 1 year outcomes will be available in early 2019. The details of the trials, trial results, outcomes and remaining clinical questions are summarised in this article.

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Neurologic Complications of Unprotected Transcatheter Aortic Valve Implantation (from the Neuro-TAVI Trial)

Cited by 75 publications

References 23 publications

The first love, you never forget. The last heart valve, you might remember better than the first

The first love, you never forget. The last heart valve, you might remember better than the first

Cognitive Outcomes After Transcatheter Aortic Valve Implantation: A Metaanalysis

Clinical trials of transcatheter aortic valve replacement

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