Abstract 4626: Neurological and Cognitive Function After Percutaneous Transapical Aortic Valve Implantation With the Edwards SAPIEN™ Stent Valve Bioprosthesis
Objective: Transapical transcatheter aortic valve implantation (TA-TAVI) is a reasonable alternative to open heart surgery for the treatment of severe aortic valve stenosis in surgical high-risk patients. This study intended to assess the midterm functional outcome and extent of cerebral tissue injury related to the procedure.
Methods: Since October 2007, 18 patients (mean age 82.7 years, EuroSCORE 44.5±18.9%) undergoing TA-TAVI were prospectively studied. Neurological examination, neuropsychological testing and diffusion-weighted (DW) MRI were performed at baseline, before discharge and by 3 months postoperatively. Comprehensive neuropsychological evaluation included tests on verbal learning/memory, working memory, verbal fluency and overall performance.
Results: Following TA-TAVI, 2 patients died in-hospital and 2 during follow-up (overall mortality 22%). There was no stroke up to 3 months. Individual cognitive deficits relative to baseline (decline in z-scores ≥1 SD in ≥2/4 cognitive domains) occurred in 7/16 (44 %) and 1/8 (13%) patients at discharge and at follow-up, respectively. On group level, early postoperative cognitive decline affected all domains (ANOVA using z-scores: main effect of time; no interaction between time and cognitive domains). At discharge, 4/10 patients (40%) undergoing DW MRI had new cerebral ischemic lesions. The number of lesions ranged from 2 to 4, and their cumulative volume from 95 to 750 μl per patient. At 3-month follow-up, no new lesions were observed. There was no correlation of cognitive deficits to ischemic lesions, procedural or demographic variables.
Conclusions: TA-TAVI resulted in a remarkably low incidence of significant persisting cognitive impairment and was not associated with a stroke at 3 months postoperatively. Additional studies are required to confirm these findings, particularly head-to-head comparisons with open surgical aortic valve replacement in different risk populations.