Abstract 14669: Neurological Injury in Intermediate Risk Transcatheter Aortic Valve Implantation
Background: The application of TAVI to intermediate-risk cohorts is a controversial issue. In particular, significant concern surrounds the poorly defined incidence of neurological injury. While the attendant incidence is acceptable in high-risk and inoperable patients, it may not be so in lower-risk patients.
Methods: Forty patients undergoing TAVI with the Edwards SAPIEN-XT™ prosthesis were prospectively studied. Participants underwent rigorous risk factor assessment including carotid ultrasonography, and computed tomography of the chest. Subclinical neurological injury was assessed using DWI sequences, pre-procedure and at 3±1 days post-procedure. Clinically apparent injury was assessed using the NIHSS, MoCA, and CAM tools out to 6 months post procedure.
Results: The mean±SD participant age was 82±7 years, with a STS score of 5.1±2.5% and a EuroSCORE II of 4.8±2.4%. There was one (2.5%) minor stroke, one (2.5%) episode of postoperative delirium, and two patients (5%) suffered significant postoperative cognitive dysfunction. Sixty-eight new DWI lesions were identified in 60% of participants, with a median±IQR of 1±3 lesions/patient, 24±19 μL/lesion (Figure 1) and 89±218 μL/patient. These were independently associated with a statistically significant reduction in early cognition (Figure 2).
Conclusions: Objectively measured structural and functional neurological injuries remain a concern in intermediate-risk patients undergoing TAVI. These may be of increasing significance in this compared to higher-risk cohorts due to longer life expectancy for neurological sequelae to manifest and the availability of other well established management options.
Author Disclosures: J.P. Fanning: None. A.J. Wesley: None. D.L. Walters: Honoraria; Significant; Edwards LifeSciences. Consultant/Advisory Board; Significant; Edwards LifeSciences, Medtronic, Boston Scientific. E.M. Eeles: None. A.G. Barnett: None. A.J. Clarke: None. D.G. Platts: None. A.A. Wong: None. W. Strugnell: None. C. O’Sullivan: None. O. Tronstad: None. J.F. Fraser: None.
- © 2016 by American Heart Association, Inc.