Abstract 2980: Cerebral Embolism After Transapical Aortic Valve Implantation
Objectives - Transapical aortic valve implantation is a new method for treatment of very high-risk patients with aortic valve stenosis. The risk of procedural cerebral embolism is unknown. We examined the incidence of postoperative neurological events and compared it with the results of pre-and postoperative computed tomography (CT).
Methods - Between April 2008 and Mai 2009, 114 consecutive high-risk patients (mean age: 78±10 years; mean EuroSCORE: 39±20%; mean STS mortality score: 23±19%) underwent transapical aortic valve implantation. The patients were examined pre- and postoperatively for new neurological complications. Preoperative clinical neurological examinations and CT imaging data revealed the diagnosis of old single or multiple cerebral emboli or infarcts in 38 patients (33%). Postoperative CT examinations were performed during the first week after the operation.
Results - Postoperatively, CT examinations of the brain revealed in six patients (5%) new ischemic areas with a diameter ranging between 2.8 mm and 3.7 mm. These were a small subcortical lesion on the left side, an ischemic area in the left and frontal parietal white matter, local hypodensity in the corona radiate, and an ischemic area in the right and left brain stem ganglia. No patient had any clinical signs of new cerebral embolism early after the operation. There were also no clinical signs of other peripheral embolism.
Conclusions -Transapical aortic valve implantation may be complicated by cerebral emboli. In CT examinations these were verified in some patients. However, in all cases the emboli were extremely small. None of our patients manifested clinical signs of new neurological deficits.