Neurological Injury in Intermediate-Risk TAVR

Nov 17, 2016
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Authors:
Fanning JP, Wesley AJ, Walters DL, et al.
Citation:
Neurological Injury in Intermediate-Risk Transcatheter Aortic Valve Implantation. J Am Heart Assoc 2016;Nov 15:[Epub ahead of print].
Summary By:
Troy M LaBounty, MD, FACC

Study Questions:

What is the frequency of neurologic injury after transcatheter aortic valve replacement (TAVR) for intermediate-risk patients?

Methods:

This study examined 40 intermediate-risk patients treated with a balloon-expandable TAVR device, and assessed the frequency of clinically apparent injury, and subclinical neurological injury by magnetic resonance imaging (MRI) including diffusion-weighted imaging.

Results:

Mean age was 82 ± 7 years, and the Society of Thoracic Surgeons mean score was 5.1 ± 2.5%. Clinical assessments identified no major strokes, one (3%) minor stroke, one (3%) postoperative delirium, and two (5%) cases of postoperative cognitive dysfunction. MRI identified 68 new lesions in 60% of individuals. The presence (vs. absence) of these lesions was associated with a reduction in early cognitive score (change -3.5 ± 1.7 vs. 0.4 ± 3.2, p < 0.001).

Conclusions:

Subclinical neurologic injuries are common in intermediate-risk patients following TAVR.

Perspective:

Neurologic injuries are some of the most feared complications of TAVR, and while the risk of major stroke is low, the risk of subclinical neurologic events appears much higher, with prior studies generally demonstrating rates exceeding 60% in higher-risk cohorts. This small prospective study of intermediate-risk patients observed subclinical neurologic events in 60% of individuals, with clinical events noted in only four patients (all of whom had resolution of symptoms during follow-up). While it is reassuring that no patients had clinical events with long-term symptoms, subclinical events were common, and often manifested as neurocognitive deficits that could be missed easily during typical stroke assessments.

Keywords: AHA Annual Scientific Sessions, Aortic Valve Stenosis, Cardiac Surgical Procedures, Cognition, Delirium, Heart Valve Diseases, Diffusion Magnetic Resonance Imaging, Geriatrics, Magnetic Resonance Imaging, Risk Assessment, Stroke, Transcatheter Aortic Valve Replacement, AHA16


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