Evolution of Cognitive Function After Transcatheter Aortic Valve Implantation

Abstract

Consecutive patients ≥70 years with symptomatic severe aortic stenosis and referred for TAVI evaluation to Bern University Hospital, Background-This study aimed to assess the evolution of cognitive function after transcatheter aortic valve implantation (TAVI). Previous smaller studies reported conflicting results on the evolution of cognitive function after TAVI. Methods and Results-In this prospective cohort, cognitive function was measured in 229 patients ≥70 years using the Mini Mental State Examination before and 6 months after TAVI. Cognitive deterioration or improvement was defined as change of ≥3 points decrease or increase in the Mini Mental State Examination score between baseline and follow-up. Cognitive deterioration was found in 29 patients (12.7%). Predictive analysis using logistic regression did not identify any statistically significant predictor of cognitive deterioration. A review of individual medical records in 8 patients with a major Mini Mental State Examination score decrease of ≥5 points revealed specific causes in 6 cases (postinterventional delirium in 2; postinterventional stroke, progressive renal failure, progressive heart failure, or combination of preexisting cerebrovascular disease and mild cognitive impairment in 1 each). Among 48 patients with impaired baseline cognition (Mini Mental State Examination score <26 points), 18 patients (37.5%) cognitively improved. The preinterventional aortic valve area was lower in patients who cognitively improved (median aortic valve area 0.60 cm 2 ) as compared with patients who did not improve (median aortic valve area 0.70 cm 2 ; P=0.01). Conclusions-This is the first study providing evidence that TAVI results in cognitive improvement among patients who had impaired preprocedural cognitive function, possibly related to hemodynamic improvement in patients with severe aortic stenosis. Our results confirm that some patients experience cognitive deterioration after TAVI. (Circ Cardiovasc Interv. 2016;9:e003590.

Postoperative Delirium in Individuals Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta‐Analysis

“…The majority of participants included in our meta‐analysis were derived from 2 large prospective registries, with the lack of information regarding delirium diagnostic criteria and timing of the delirium screening . Interestingly, while these 2 large studies reported lower incidence of IHPOD after TAVR (e.g., 3.8% and 4.6%), small studies included in our analysis report higher incidence of IHPOD after TAVR . Several participant‐ and procedural‐related factors, including age at admission, comorbid condition, TAVR access, and hospital complication rate, could explain the differences in the incidence of IHPOD between these studies.…”

“…2,3 Studies have generally shown no change in cognition or cognitive improvement at 3 to 6 months follow-up after TAVR. [4][5][6][7] According to other studies, inhospital postoperative delirium (IHPOD) is frequently observed early after TAVR 8,9 and is associated with prolonged hospital stay, readmission, and mortality after TAVR, thus being an important clinical concern. 8, 10,11 Delirium is an acute confusional state, characterized by disturbed consciousness, altered cognition, and inattention.…”

Cognitive Outcomes After Transcatheter Aortic Valve Implantation: A Metaanalysis

“…Cognitive function 6 months after TAVI was assessed in 4 studies (n = 326) . Overall cognitive performance remained unchanged 6 months after TAVI (SMD = −0.06, 95% CI = −0.21–0.10; z = 0.73, p = .47) (Figure ).…”

“…In studies with multiple TAVI intervention groups, groups were combined for the overall analysis . For studies that did not report means and standard deviations of cognitive scores, the values were extracted from graphs or calculated (from medians, interquartile ranges, or confidence intervals (CIs)) using the Cochrane Handbook for Systematic Reviews of Interventions guidelines…”

“…Cognitive function 6 months after TAVI was assessed in 4 studies (n = 326). 21,23,43,45 Overall cognitive performance remained unchanged 6 months after TAVI (SMD = À0.06, 95% CI = À0.21-0.10; z = 0.73, p = .47) ( Figure 3). No significant heterogeneity (chi-square (3) = 1.6, P = .66, I 2 = 0.0%) was detected, and there were no differences between included studies assessing cognition using different scales in subgroup analysis (chi-square (1) = 0.51, P = .47).…”