Abstract 18053: Neurological Risk During Transcatheter Aortic Valve Implantation
Background: Transcatheter aortic valve implantation (T-AVI) is being performed by manipulating native calcified aortic valve cusps and the potentially calcified aortic arch. We evaluated whether the techniques of transfemoral (TF) and transapical (TA) AVI have an increased risk of neurological damage than conventional aortic valve replacement (AVR).
Methods: 121 elderly high-risk patients underwent AVR (n=27, stented-bioprosthesis), TF-AVI (n=44, CoreValve™) or TA-AVI (n=50, SAPIEN™). Mean age was comparable (AVR:82±1, TF:80±1, TA:82±0.7; p=n.s.) whereas TA-patients had a significantly higher risk-profile (logES/STS-score: AVR=16±2/7±1; TF= 23±2/6±0.4; TA=29±2/12±1;p<0.05). Micro-embolic load was assessed by transcranial Doppler, macro-emboli by MRI-scan and neurocognitive outcome by a test battery. S100B was determined as a marker for brain ischemia.
Results: Valve implantation was successful in all patients. 30-day mortality was 1 (AVR), 8 (TF) and 7 (TA). One stroke occurred in the AVR, 1 in the TF and none in the TA group. TA was associated with significantly less solid and gaseous micro-emboli (Figure1A). The most prone step for cerebral emboli was: AVR: X-clamping and declamping (Fig.1B). TF: retrograde passage of the aortic arch and the aortic valve and valve implantation (Fig.1C). TA: passage of the aortic valve and positioning (Fig.1D). Postoperative transitional delir was seen in 4 patients (AVR), 3 (TF) and 6 (TA). Postoperative MRI-scan revealed new brain-lesions in 29% (AVR), in 59% (TF) and in 50% (TA). S100B demonstrated no significant differences between groups 48h after surgery. At discharge the neurocognitive tests demonstrated no significant differences.
Conclusions: Compared to TF and AVR TA is associated with significantly less intraoperative cerebral micro-emboli despite a higher risk profile of the patients. The risk of macro-emboli seems to be higher after T-AVI but does not affect the neurocognitive outcome.
- © 2010 by American Heart Association, Inc.