Neurologic Complications of Unprotected Transcatheter Aortic Valve Implantation (from the Neuro-TAVI Trial)

Cognitive Outcomes After Transcatheter Aortic Valve Implantation: A Metaanalysis

“…Although some may argue that microembolization contributes to cognitive decline postoperatively, the literature is divided as to whether there is an effect of embolic load on postoperative neurocognitive dysfunction . Cognitive changes were not related to number of perioperative cerebral lesions or incidence of stroke in our analysis, although this may have been due to brain lesions and cerebrovascular events that lead to higher dropout rates and subsequently confound cognitive evaluations …”

“…Perioperative cerebrovascular accidents (CVAs) were reported in 3% of participants in 14 studies, and no participants were lost to follow‐up because of a CVA. Ten studies reported cerebral microembolic lesions after TAVI using diffusion‐weighted magnetic resonance imaging, of which only one associated higher dropout rates with more‐extensive brain lesions, which may confound cognitive evaluations …”

“…One study assessed cognitive outcomes using a global cognitive dimension score, a composite score derived from a battery of various standardized neuropsychological tests as described previously . In addition, four studies conducted additional neurocognitive batteries assessing cognitive function in multiple cognitive domains using the Digit Symbol Substitution Test, Trail‐Making Test Parts (TMT) A and B, and tests of category and letter fluency …”

“…Seven studies assessed cognitive outcomes one month after TAVI (n = 287) . Overall cognitive performance significantly improved after TAVI (SMD = −0.33, 95% CI = −0.50 to −0.16; z = 3.83, P < .001) (Figure ).…”

Clinical trials of transcatheter aortic valve replacement

“…Clinical stroke rates can be as low as 1.6% in some TAVR series; however, as per the recent American Heart Association/American Stroke Association (AHA/ASA) guidelines, radiographic evidence of cerebral infarction can be detected in the majority of patients undergoing TAVR 12. In conjunction with expanding indications in intermediate-risk patients and the possible inclusion of low-risk patients, optimising TAVR outcomes has been of increased focus using cerebral embolic protection devices.…”