Abstract 12191: The Posterior Circulation and Right Hemisphere are Particularly Vulnerable to Neurological Insult During Transcatheter Aortic Valve Replacement (TAVR)
Introduction: Stroke is among the most feared complication for patients undergoing TAVR. Despite maturation of the procedure, cerebrovascular events (CVEs) remain poorly defined, with clinically apparent CVEs representing only the ‘tip-of-the-iceberg’. MRI detection of cerebral infarction provides a useful surrogate marker for characterizing the full extent of cerebrovascular injury in this setting.
Hypothesis: Anatomical distribution of MRI-defined brain infarction is heterogeneous involving multiple vascular territories in a classical embolic pattern.
Methods: Thirty-six patients undergoing TAVR with the Edwards SAPIEN-XTTM at The Prince Charles Hospital, Australia, were prospectively enrolled. Participants underwent brain MRI, including diffusion weighted imaging (DWI) sequences, pre-procedure and 3 days post-procedure. Clinical assessment for CVEs included serial National Institute of Health stroke scale assessments at baseline, daily for 3 days post-procedure and again at 6 weeks.
Results: The mean (±SEM) participant age was 82.17 (±1.1) years. Patients were of a moderate-to-high risk with Society of Thoracic score 6.29 (±0.09) and EuroSCORE II 6.75 (±1.1). There were no clinically apparent CVEs. MRI assessments identified 81 new DWI lesions in 16 of 27 participants (59.26%), mean 2.54 (±0.77) lesions/patient and 0.14 (±0.08) cm3/lesion. Anatomical characterization of these lesions can be found in the Table.
Conclusions: Subclinical neurological injury is common with TAVI. Injury is predominantly right-sided, cortical and involving the posterior cerebral circulation. These results reveal unique considerations for neuroprotective strategies in TAVI.
- cerebrovascular disorders
- embolism and thrombosis
- heart valve prosthesis implantation
- magnetic resonance imaging
Author Disclosures: J.P. Fanning: None. A.J. Wesley: None. D.L. Walters: Other Research Support; Significant; Edwards, Medtronic and Boston Scientific. Consultant/Advisory Board; Significant; Medtronic and Edwards LifeSciences. D.G. Platts: None. J.F. Fraser: None.
- © 2015 by American Heart Association, Inc.