Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients

Altisent, Omar Abdul‐Jawad; Ferreira‐González, Ignacio; Marsal, Josep Ramón; Ribera, Aída; Auger, Cristina; Ortega, Gemma; Cascant, Purificación; Ureña, Marina; Blanco, Bruno García del; Serra, Violeta; Sureda, Carlos; Igual, A; Rovira, Àlex; González‐Alujas, M.T.; González, Anna; Puri, Rishi; Cuéllar, Hug; Tornos, Pilar; Rodés‐Cabau, Josep; Garcı́a-Dorado, David

doi:10.1007/s00392-015-0946-9

Cited by 43 publications

(19 citation statements)

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“…Yet, it is possible that the global FLAIR lesion volume metric employed in the current study may be either insensitive to or under‐estimate the impact of perioperative cerebrovascular damage on brain functional networks. Evidence from neuroimaging studies conducted during the acute in‐hospital recovery phase (i.e., day 2–7) after open and transcatheter cardiac surgery indicate the presence of significant increases in emboli‐related diffusion‐weighted imaging (DWI) lesion volumes (Abdul‐Jawad Altisent et al, ). The majority of these DWI‐detected lesions resolve and are not visible on standard FLAIR scans beyond the acute recovery period (e.g., 4–6 weeks after surgery).…”

Section: Discussionmentioning

confidence: 99%

Task‐related changes in degree centrality and local coherence of the posterior cingulate cortex after major cardiac surgery in older adults

Browndyke

Berger

Smith

et al. 2017

Human Brain Mapping

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Objectives: Older adults often display postoperative cognitive decline (POCD) after surgery, yet it is unclear to what extent functional connectivity (FC) alterations may underlie these deficits. We examined for postoperative voxel-wise FC changes in response to increased working memory load demands in cardiac surgery patients and nonsurgical controls.Experimental design: Older cardiac surgery patients (n 5 25) completed a verbal N-back working memory task during MRI scanning and cognitive testing before and 6 weeks after surgery; nonsurgical controls with cardiac disease (n 5 26) underwent these assessments at identical time intervals. We measured postoperative changes in degree centrality, the number of edges attached to a brain node, and local coherence, the temporal homogeneity of regional functional correlations, using voxel-wise graph theory-based FC metrics. Group 3 time differences were evaluated in these FC metrics associated with increased N-back working memory load (2-back > 1-back), using a two-stage partitioned variance, mixed ANCOVA.Principal observations: Cardiac surgery patients demonstrated postoperative working memory load-related degree centrality increases in the left dorsal posterior cingulate cortex (dPCC;

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Section: Discussionmentioning

confidence: 99%

Task‐related changes in degree centrality and local coherence of the posterior cingulate cortex after major cardiac surgery in older adults

Browndyke

Berger

Smith

et al. 2017

Human Brain Mapping

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“…2,3 Although the interest in postprocedural stroke in patients undergoing TAVI or SAVR is growing, comparative studies between the two modalities are sparse. 2,4 We performed a comprehensive systematic review and a meta-analysis of the published studies to compare the incidence of stroke and disabling stroke at 30 days and 1 year among patients undergoing TAVI and SAVR.…”

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confidence: 99%

Meta-Analysis Comparing the Frequency of Stroke After Transcatheter Versus Surgical Aortic Valve Replacement

Shah¹,

Chaker²,

Busu³

et al. 2018

The American Journal of Cardiology

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Stroke is one of the most feared complications of aortic valve replacement. Although the outcomes of transcatheter aortic valve implantation (TAVI) improved substantially over time, concerns remained about a potentially higher incidence of stroke with TAVI compared with surgical replacement (SAVR). However, comparative data are sparse. We performed a meta-analysis comparing the incidence of stroke among patients undergoing TAVI versus SAVR. Of the 5067 studies screened, 28 eligible studies (22 propensity-score matched studies and 6 randomized trials) were analyzed. Primary endpoints were 30-day stroke and disabling stroke. Secondary endpoints were 1-year stroke and disabling stroke. A total of 23,587 patients were included, of whom 47.27% underwent TAVI and 52.72% underwent SAVR. For each endpoint, pooled estimates of odds ratio (OR) with 95% confidence interval (CI) were calculated. The pooled estimates for stroke (2.7% vs 3.1%, OR 0.86; 95% CI 0.72 to 1.02; p=0.08) and disabling stroke (2.5% vs 2.9%, OR 0.96; 95% CI 0.57 to 1.62; p=0.89) were comparable following TAVI versus SAVR at 30 days. Similarly, the pooled estimates for stroke (5.0% vs 4.6%, OR 1.01; 95% CI 0.79 to 1.28; p=0.96) and disabling stroke (4.1% vs 4.5%, OR 0.92; 95% CI 0.92 to 1.39; p=0.71) were similar at 1 year. A sensitivity analysis including only RCTs yielded similar results. Our meta-analysis documents comparable rates of strokes and disabling strokes following TAVI or SAVR both at 30 days and 1 year.

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“…For this reason all but 1 study limited the postoperative scan to between 2 and 7 days. The 1 study that published a lower incidence of DWI lesions (45%), and the only other study that was performed in intermediate‐risk patients, permitted scans up to 15 days postprocedure, thus allowing the potential extinction of imaging changes, which would result in an underestimation of the true incidence . The importance of the timing of the early postoperative MRI scan cannot be overstated, especially in this setting, where the majority of infarcts are small and the primary endpoint is dichotomous (lesion present or not).…”

Section: Discussionmentioning

confidence: 99%

“…This signal loss can result in these lesions easily disappearing, significantly confounding further analysis. Furthermore, in the same study, baseline MRIs were not performed to assess whether DWI lesions were in fact new postprocedure …”

Section: Discussionmentioning

confidence: 99%

Neurological Injury in Intermediate‐Risk Transcatheter Aortic Valve Implantation

Fanning

Wesley

Walters

et al. 2016

JAHA

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BackgroundThe application of transcatheter aortic valve implantation (TAVI) to intermediate‐risk patients is a controversial issue. Of concern, neurological injury in this group remains poorly defined. Among high‐risk and inoperable patients, subclinical injury is reported on average in 75% undergoing the procedure. Although this attendant risk may be acceptable in higher‐risk patients, it may not be so in those of lower risk.Methods and ResultsForty patients undergoing TAVI with the Edwards SAPIEN‐XT ™ prosthesis were prospectively studied. Patients were of intermediate surgical risk, with a mean±standard deviation Society of Thoracic Surgeons score of 5.1±2.5% and a EuroSCORE II of 4.8±2.4%; participant age was 82±7 years. Clinically apparent injury was assessed by serial National Institutes of Health Stroke Scale assessments, Montreal Cognitive Assessments (MoCA), and with the Confusion Assessment Method. These identified 1 (2.5%) minor stroke, 1 (2.5%) episode of postoperative delirium, and 2 patients (5%) with significant postoperative cognitive dysfunction. Subclinical neurological injury was assessed using brain magnetic resonance imaging, including diffusion‐weighted imaging (DWI) sequences preprocedure and at 3±1 days postprocedure. This identified 68 new DWI lesions present in 60% of participants, with a median±interquartile range of 1±3 lesions/patient and volumes of infarction of 24±19 μL/lesion and 89±218 μL/patient. DWI lesions were associated with a statistically significant reduction in early cognition (mean ΔMoCA −3.5±1.7) without effect on cognition, quality of life, or functional capacity at 6 months.ConclusionsObjectively measured subclinical neurological injuries remain a concern in intermediate‐risk patients undergoing TAVI and are likely to manifest with early neurocognitive changes.Clinical Trial Registration URL: http://www.anzctr.org.au. Australian & New Zealand Clinical Trials Registry: ACTRN12613000083796.

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Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients

Abstract: TAVI and SAVR were associated with a similar rate of acute silent ischemic cerebral lesions in intermediate risk patients. Although acute lesions occurred very frequently in both strategies, their cognitive impact was not clinically relevant.

Cited by 43 publications

References 32 publications

Task‐related changes in degree centrality and local coherence of the posterior cingulate cortex after major cardiac surgery in older adults

Task‐related changes in degree centrality and local coherence of the posterior cingulate cortex after major cardiac surgery in older adults

Meta-Analysis Comparing the Frequency of Stroke After Transcatheter Versus Surgical Aortic Valve Replacement

Neurological Injury in Intermediate‐Risk Transcatheter Aortic Valve Implantation

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