Abstract 10838: Neurological Damage After Transcatheter Aortic Valve Implantation Versus Aortic Valve Replacement In Patients With Comparable Surgical Risk: Preliminary Data
There are no studies comparing the incidence of acute silent cerebral ischemic lesions and neurocognitive dysfunction following TAVI vs. conventional aortic valve replacement (AVR) in contemporary patients with comparable surgical risk.
These are the preliminary results of a study comparing the incidence of silent cerebral embolism and neurocognitive dysfunction following TAVI vs AVR in high risk patients. Thirty-one consecutive patients (p) undergoing TAVI were compared to 27 contemporary p with log EuroScore (ES) >10% undergoing AVR. Diffuse weighted Magnetic Resonance Imaging (MRI) was performed in 47 p (25 TAVI and 22 RVA; mean time after intervention 6.6 days) to evaluate acute cerebral damage. A comprehensive neurocognitive assessment was performed at baseline and at 3 months by a neuropsychologist in 41 p (26 TAVI and 15 RVA) following the recommendations of the “Statement of Consensus on Assessment of Neurobehavioural Outcome After Cardiac Surgery”. Potential cognitive decline from baseline was determined using the Reliable Change Index (RCI).
Both groups were comparable concerning age (TAVI mean age 76.8 y vs. 75.0 y in AVR, p=0.6) and Log ES (12.6±7,1 in TAVI vs 14.6±5.8 in AVR, p=0.25). Eighteen out of 47 p (38.3%) had new ischemic lesions in post-intervention MRI images, 10 (40%) in TAVI group vs 8 (36%) in AVR group (p=0.8), consistent with cerebral embolization. Both, the mean ischemic volume and the number of lesions were smaller in the TAVI group, (although not statistically significant): median volume (Q1-Q3) 387 mm3 (168-745) in TAVI vs 628 mm3 (203-1069) in RVA, p=0,42; median of 2.5 lesions in TAVI vs. 4 lesions in RVA, p=0,42). RCI showed cognitive decline in 5 out of 41 p (12.2%) assessed, 3 out of 26 p (11.5%) in TAVI and 2 out of 15 p (13.3%) in AVR group (p=0.7). Cognitive decline was not considered to have clinical relevance after expert assessment. There was no correlation between the volume of ischemic lesions and neurocognitive decline.
In patients with comparable surgical risk preliminary data show a similar rate of silent ischemic foci detected by DW-MRI after TAVI and after AVR. Furthermore, neurocognitive decline is not clinically relevant after both techniques and it does not correlate with the size and number of cerebral ischemic lesions.
- © 2013 by American Heart Association, Inc.