Serial Changes in Cognitive Function Following Transcatheter Aortic Valve Replacement

Auffret, Vincent; Campelo‐Parada, Francisco; Regueiro, Ander; Trigo, María Del; Chiche, Olivier; Chamandi, Chekrallah; Allende, Ricardo; Córdoba-Soriano, Juan G.; Paradis, Jean‐Michel; Larochellière, Robert De; Doyle, Daniel; Dumont, Éric; Mohammadi, Siamak; Côté, Mélanie; Marrero, Alier; Puri, Rishi; Rodés‐Cabau, Josep

doi:10.1016/j.jacc.2016.08.046

Cited by 64 publications

(81 citation statements)

References 34 publications

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“…Further, in light of emerging research, it is important to summarize the evolving patterns of AKI temporally, because with the currently available long‐term follow‐up data, unexpected possible benefits such as cognitive‐function improvement are being reported despite the presence of subclinical ischemia in patients who have undergone TAVR …”

Section: Importance and Definitionmentioning

confidence: 99%

Acute kidney injury post–transcatheter aortic valve replacement

Ram

Mezue

Pressman

et al. 2017

Clinical Cardiology

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Transcatheter aortic valve replacement (TAVR) is a treatment option in high-risk patients with severe aortic stenosis who are not surgical candidates. In light of emerging evidence, it is being increasingly performed even in intermediate-risk patients in recent years. Patients who develop acute kidney injury (AKI) following TAVR are known to have worse outcomes. The objective of this concise review was to identify the prevalence and the impact of AKI following TAVR on patient outcomes by including the most recent literature in our search. After a thorough search on MEDLINE, Google Scholar, and PubMed, we included all literature relevant to AKI following TAVR. We found that AKI was caused by a variety of reasons, such as hemodynamic instability during rapid pacing, blood transfusion, periprocedural embolization, and use of contrast medium, to name a few. In patients who developed AKI following TAVR, 30-day and 1-year mortality were increased. Further, in these patients, length and cost of hospital stay were increased as well. Preventive measures such as optimal periprocedural hydration, careful contrast use, and techniques to prevent embolization during device implantation have been tried with limited success. Given that TAVR is expected to be increasingly performed, this review aimed to summarize the rapidly expanding currently available literature in an effort to reduce procedural complications and thereby improve patient outcomes.

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Section: Importance and Definitionmentioning

confidence: 99%

Acute kidney injury post–transcatheter aortic valve replacement

Ram

Mezue

Pressman

et al. 2017

Clinical Cardiology

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“…2,3 Studies have generally shown no change in cognition or cognitive improvement at 3 to 6 months follow-up after TAVR. [4][5][6][7] According to other studies, inhospital postoperative delirium (IHPOD) is frequently observed early after TAVR 8,9 and is associated with prolonged hospital stay, readmission, and mortality after TAVR, thus being an important clinical concern. 8, 10,11 Delirium is an acute confusional state, characterized by disturbed consciousness, altered cognition, and inattention.…”

mentioning

confidence: 99%

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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“…This might be because of the older age of the participants in this study. In fact, the average MoCA‐J score in the present study did not differ from that of a study targeted at participants of the same age . The third limitation is that we could not take into account the duration of the loss of posterior occlusal support.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, the average MoCA-J score in the present study did not differ from that of a study targeted at participants of the same age. 29 The third limitation is that we could not take into account the duration of the loss of posterior occlusal support. If the loss of posterior occlusal support is a burden on cognitive function, it is also important to know how long participants have been without posterior occlusal support.…”

Section: Discussionmentioning

confidence: 99%

Influence of lack of posterior occlusal support on cognitive decline among 80‐year‐old Japanese people in a 3‐year prospective study

Hatta

Ikebe

Gondo

et al. 2018

Geriatrics Gerontology Int

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Aim Previous studies have reported significant associations between tooth loss or periodontal status and cognitive function; however, animal experimental studies have shown that occlusion might be a more important factor in cognitive decline. The purpose of the present study was to investigate the influence of a lack of posterior occlusal support by residual teeth on the decline of cognitive function over a 3‐year period among 80‐year‐old Japanese people. Methods Participants were community‐dwelling older adults (n = 515, age 79–81 years). Cognitive function was measured using the Japanese version of the Montreal Cognitive Assessment. At baseline, participants were divided into two groups: those with and without posterior occlusal support. Participants whose Japanese version of the Montreal Cognitive Assessment score decreased by ≥3 points over the 3‐year period were defined as the declined group. Logistic regression was carried out for the decline in Japanese version of the Montreal Cognitive Assessment scores, including dental status and possible risk factors as independent variables. Results More participants without posterior occlusal support tended to be in the cognitive decline group (49.4%) than in the maintained group (38.5%; χ2‐test, P = 0.02). Logistic regression analysis showed that a lack of posterior occlusal support was a significant variable (odds ratio 1.55, P = 0.03) for cognitive decline, even after adjusting for other risk factors. However, the number of teeth or mean periodontal pocket depth was not significantly correlated with cognitive decline. Conclusions The present findings suggest that a lack of posterior occlusal support predicted the incidence of cognitive decline, even after adjusting for possible risk factors in community‐dwelling old‐old people. Geriatr Gerontol Int 2018; 18: 1439–1446.

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Serial Changes in Cognitive Function Following Transcatheter Aortic Valve Replacement

Abstract: TAVR was associated with global improvement in cognitive status, more pronounced among those with cognitive impairment pre-TAVR. However, early decline in some complex cognitive functions was observed in one-quarter of TAVR recipients, persisting at 1 year in 10% of patients.

Cited by 64 publications

References 34 publications

Acute kidney injury post–transcatheter aortic valve replacement

Acute kidney injury post–transcatheter aortic valve replacement

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

Influence of lack of posterior occlusal support on cognitive decline among 80‐year‐old Japanese people in a 3‐year prospective study

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