Abstract 11127: Impact of Cerebral Embolism related to Transfemoral Aortic Valve Implantation on Neurocognitive Function — Prospective Study with Diffusion-Weighted Magnetic Resonance Imaging
Background: Risk of silent and apparent cerebral embolic events for aged, multimorbid patients undergoing transfemoral aortic valve implantation (TAVI) is high. Hence, strategies are needed to identify individuals at risk for peri-interventional embolism, so preventive strategies can be implemented. We prospectively investigated quality of life (QoL) and neurocognitive function and their relationship to cerebral embolism with diffusion-weighted magnetic resonance imaging (DW-MRI), as well as clinical and serologic parameters of brain injury.
Methods: Serial cerebral DW-MRI was performed before (E1), directly (E2) and 3 (E3) months after TAVI with the current third-generation self-expanding Corevalve™ prosthesis. At this timepoints, a repeatable battery of standardized neuropsychological tests (immediate and delayed memory, visuospatial and constructional cognition, attention and language) and valid questionnaires on health-related QoL and on activities of daily living (ADL) were applied. Further, focal neurological impairment was assessed at E1-3 and 12 months after TAVI (E4) according to the National Institutes of Health Stroke Scale (NIHSS) and serum concentration of neuron-specific enolase (NSE) was measured (E1-4).
Results: Fourty patients were enrolled, 30 completed imaging protocol and follow-up (Age: 81 +/−4y, EuroScore: 21 +/−8%). Four patients (10%) had transient, focal neurological findings directly after TAVI (E2), of whom only 2 (4%) had persistent neurological impairment in E3 and 4. Of the 30 TAVI patients with complete imaging data, 23 (77%) had new cerebral embolic lesions. The 7 patients without peri-interventional embolism revealed no significant differences in their baseline characteristics. Neurocognition, QoL, NIHSS and NSE were not associated with DW-MRI lesions. 16% and 6% of patients demonstrated significant neurocognitive impairment from their baseline function at E2 and E3, respectively.
Conclusion: Embolic lesions in DW-MRI were abundant, but not related to impairment of QoL, ADL and cognitive function. Ultimately, TAVI is not associated with short- and middle-term neurocognitive impairment in the majority of patients.
- © 2010 by American Heart Association, Inc.