Transfemoral Versus Conventional Aortic Valve Implantation^|^#8212; Early Postoperative Cognitive Outcome ^|^#8212;

Abstract

Objectives: Reduction of cognitive function is a possible side effect after cardiac surgery. We investigated the effect of transfemoral versus conventional aortic valve replacement on cognitive performance early after surgery. Methods: 50 patients with transfemoral, catheter-based aortic valve implantations were compared to 50 patients with conventional surgical aortic valve replacement. Six neuropsychological subtests from the Syndrom Kurz Test and Alzheimer's Disease Assessment Scale were performed preoperatively and on the third postoperative day in a double blind fashion. To assess the overall cognitive function and the degree of cognitive change across all tests after surgery we combined the six test-scores by principal component analysis. Results: The preoperative (S pre ), as well as postoperative (S post ) overall cognitive function scores, were not significantly different between the groups and showed deterioration within both groups (S pre conv. 0.2 ± 1.0 vs S post conv. −0.6 ± 1.1, p <0.0005 and S pre transfem. −0.2 ± 1.0 vs S post transfem. −0.6 ± 1.1, p = 0.002). This decline (S pre −Spost) was not associated with the type of operation (p = 0.1). Conclusion: Transfemoral aortic valve implantation has no cerebroprotective advantage since it leads also to an early postoperative decline of neuropsychological abilities, which is comparable to conventional aortic valve replacement.

Evolution of Cognitive Function After Transcatheter Aortic Valve Implantation

“…12 Results of the other 3 smaller studies were inconclusive, with 2 reporting mild deterioration and 1 reporting improvement of cognitive function after TAVI. [13][14][15] The small numbers of patients in all of these studies resulted in a limited statistical power for the analysis of clinical predictors for cognitive change after TAVI in all these studies. We investigated the evolution of cognitive function in a large cohort of patients undergoing TAVI and assessed potential predictors for cognitive deterioration or improvement.…”

“…Only 4 small studies reported on evolution of cognitive function in TAVI patients. [12][13][14][15] In the largest one, Ghanem et al 12 evaluated the cognitive trajectory in 111 TAVI patients and found that cognitive function was preserved in the great majority throughout the first 2 years after TAVI. Cognitive deterioration was found in only 9% of the patients.…”

Efficacy and Safety of Transcatheter Aortic Valve Implantation for Bicuspid Aortic Valves: A Systematic Review and Meta-Analysis

“…7) Transcatheter aortic valve implantation (TAVI), a minimally invasive procedure that entails insertion of a bioprosthetic valve into the stenotic aortic valve through a vascular access, is a newly developed catheter-based technology for delivering aortic valve replacement. 8) And owing to the tremendous improvement in devices and growth in operator experience during the past few years, it is currently considered as an appealing alternative to surgical aortic valve replacement in severe aortic stenosis (AS) patients who are considered to be at high risk [expected mortality >20% with the European System for Cardiac Operative Risk Evaluation score (EuroSCORE) or >8% with the Society of Thoracic Surgeons score (STS score), or if surgery was expected to be risky due to serious comorbidities or advanced age] for conventional surgery, as long as life expectancy is more than one year. 9) Although TAVI has already been accepted widely in treating AS, the existence of a BAV has long been regarded as a relative contraindication for TAVI since the unfavorable anatomy of BAV may impede the positioning and expansion of the prosthetic valve, and theoretically increase the incidence of procedural complications as well as decrease the efficacy and durability of the prosthetic valve.…”

Stroke After Aortic Valve Replacement

“…Both SAVR and TAVR literature reported cognitive decline after the operation, but the clinical implication of these deficits is not well established. [7][8][9] This uncertainty is also true for silent neurological events (ie, events recorded by imaging modalities with no apparent clinical symptoms). Messé et al report a 54% incidence of silent brain infarcts that were demonstrated by diffusion-weighted imaging after the procedure in patients with no clinical neurological event.…”