Abstract 15619: Periprocedural Ischemic Events After TAVI Performed With or Without Prior Balloon Aortic Valvuloplasty
Introduction: Direct implantation of the transcather heart valve (THV) without prior balloon valvuloplasty (BAV) is commonly done with new generation devices but we lack of prospective data related to safety.
Hypothesis: We hypothesized that TAVI performed without prior BAV may be associated with decrease of periprocedural cerebral ischemia assessed by diffusion-weighted (DW) magnetic resonance imaging (MRI).
Methods: This prospective monocentric study enrolled 43 consecutive patients who had TAVI with the new generation balloon expandable SAPIEN 3 THV. Group 1 (n=20) included patients with BAV performed prior implantation of the prosthesis and group 2 (n=23) patients with direct implantation of the valve. Periprocedural cerebral ischemic events were assessed blindly by neurological testing and serial cerebral DW MRI at baseline and within 3 days after TAVI.
Results: Mean age of the patients was 83.5 ± 7.4 years, and mean logistic Euroscore II was 5.5 ± 5.7 without significant differences between the 2 groups. Implantation of the valve was successful in all patients. Considering the total population, preexisting silent ischemic brain abnormalities were observed in 15 patients (34.9%) and microbleeds in 20 patients (43.5%). New foci of restricted diffusion, mainly lacunar, and new microbleeds were found on cerebral DW MRI in respectively 20 (46.5%) and 6 (14%) patients after the procedure without significant difference between the 2 groups (table 1). There were neither apparent impairment of neurocognitive function or neurological events during the in-hospital stay in the 2 groups.
Conclusions: Direct implantation of new generation balloon expandable prosthesis appears feasible but is not associated with reduction of ischemic cerebral events after TAVI. These results argue for embolization occurring mainly during positioning of the valve.
Author Disclosures: F. Leclercq: None. J. Labour: None. M. Akodad: None. J. Macia: None. B. Lattuca: None. T. Gandet: None. N. de Champfleur: None. A. Agullo: None. H. Vernhet: None. L. Schmutz: None. B. Albat: None. G. Cayla: None.
- © 2016 by American Heart Association, Inc.