Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients

Background and purpose The risk of neurological damage following transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) in severe aortic stenosis patients deemed to be at intermediate surgical risk is unknown. In this target population, the degree of neurological damage was compared using brain diffusion-weighted magnetic resonance imaging (DW-MRI) and cognitive testing. Methods Forty-six consecutive patients undergoing TAVI (78.0 ± 8.3 years; STS score 4.4 ± 1.7) and 37 patients undergoing SAVR (78.9 ± 6.2 years, STS score 4.7 ± 1.7) were compared. DW-MRI was performed in 67 patients (40 in TAVI vs. 27 in SAVR group) within the first 15 days post-procedure. A cognitive assessment was performed at baseline and at 3 months follow-up. The occurrence of potential cognitive impairment post-intervention was determined using the reliable change index (RCI). Results Baseline characteristics were comparable in TAVI and SAVR groups except for the presence of severe calcified aorta, which occurred more frequently in the TAVI group [17 (37 %) vs. 0 (0 %), p < 0.001]. Three patients presented a clinical stroke: 1 (2.2 %) in TAVI group vs. 2 (5.4 %) in SAVR group, (p = 0.58). No differences were observed in the rate of acute ischemic cerebral lesions detected by DWI in patients undergoing TAVI vs. SAVR [18 (45 %) in TAVI vs. 11 (40.7 %) in SAVR, adjusted OR 0.95; 95 % CI 0.25–3.65; p = 0.94]. TAVI was associated with a lower number of DWI lesions (adjusted OR 0.54; 95 % IC 0.37–0.79; p = 0.02). An older age was a predictor of the occurrence of acute lesions (OR 1.13; 95 % CI 1.03–1.23; p = 0.01), and the use of vitamin-K antagonist therapy had a protective effect (OR 0.25; 95 % CI 0.07–0.92; p = 0.037) regardless the type of intervention. Overall no significant changes were observed in global cognitive scores post-intervention (p = 0.23). The RCI showed mild cognitive decline in nine patients undergoing TAVI (26.4 %) and in six patients in the SAVR group (30.0 %) (p = 0.96). There was no association between the number and total volume of lesions and the occurrence of cognitive decline (CC Spearman 0.031, p = 0.85 and −0.011, p = 0.97, respectively). Conclusions TAVI and SAVR were associated with a similar rate of acute silent ischemic cerebral lesions in intermediate risk patients. Although acute lesions occurred very frequently in both strategies, their cognitive impact was not clinically relevant. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Abdul-Jawad Altisent, Omar [verfasserIn] Ferreira-Gonzalez, Ignacio [verfasserIn] Marsal, Josep R. [verfasserIn] Ribera, Aida [verfasserIn] Auger, Cristina [verfasserIn] Ortega, Gemma [verfasserIn] Cascant, Purificación [verfasserIn] Urena, Marina [verfasserIn] Del Blanco, Bruno Garcia [verfasserIn] Serra, Vicenç [verfasserIn] Sureda, Carlos [verfasserIn] Igual, Albert [verfasserIn] Rovira, Alex [verfasserIn] González-Alujas, María Teresa [verfasserIn] Gonzalez, Anna [verfasserIn] Puri, Rishi [verfasserIn] Cuellar, Hug [verfasserIn] Tornos, Pilar [verfasserIn] Rodés-Cabau, Josep [verfasserIn] Garcia-Dorado, David [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2015

Schlagwörter:	Valves Catheterization Cardiac valvular surgery Stroke Magnetic resonance imaging

Übergeordnetes Werk:	Enthalten in: Zeitschrift für Kardiologie - Darmstadt : Steinkopff, 1997, 105(2015), 6 vom: 08. Dez., Seite 508-517
Übergeordnetes Werk:	volume:105 ; year:2015 ; number:6 ; day:08 ; month:12 ; pages:508-517

Links:	Volltext

DOI / URN:	10.1007/s00392-015-0946-9

Katalog-ID:	SPR004812395

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245	1	0	\|a Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients
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520			\|a Background and purpose The risk of neurological damage following transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) in severe aortic stenosis patients deemed to be at intermediate surgical risk is unknown. In this target population, the degree of neurological damage was compared using brain diffusion-weighted magnetic resonance imaging (DW-MRI) and cognitive testing. Methods Forty-six consecutive patients undergoing TAVI (78.0 ± 8.3 years; STS score 4.4 ± 1.7) and 37 patients undergoing SAVR (78.9 ± 6.2 years, STS score 4.7 ± 1.7) were compared. DW-MRI was performed in 67 patients (40 in TAVI vs. 27 in SAVR group) within the first 15 days post-procedure. A cognitive assessment was performed at baseline and at 3 months follow-up. The occurrence of potential cognitive impairment post-intervention was determined using the reliable change index (RCI). Results Baseline characteristics were comparable in TAVI and SAVR groups except for the presence of severe calcified aorta, which occurred more frequently in the TAVI group [17 (37 %) vs. 0 (0 %), p < 0.001]. Three patients presented a clinical stroke: 1 (2.2 %) in TAVI group vs. 2 (5.4 %) in SAVR group, (p = 0.58). No differences were observed in the rate of acute ischemic cerebral lesions detected by DWI in patients undergoing TAVI vs. SAVR [18 (45 %) in TAVI vs. 11 (40.7 %) in SAVR, adjusted OR 0.95; 95 % CI 0.25–3.65; p = 0.94]. TAVI was associated with a lower number of DWI lesions (adjusted OR 0.54; 95 % IC 0.37–0.79; p = 0.02). An older age was a predictor of the occurrence of acute lesions (OR 1.13; 95 % CI 1.03–1.23; p = 0.01), and the use of vitamin-K antagonist therapy had a protective effect (OR 0.25; 95 % CI 0.07–0.92; p = 0.037) regardless the type of intervention. Overall no significant changes were observed in global cognitive scores post-intervention (p = 0.23). The RCI showed mild cognitive decline in nine patients undergoing TAVI (26.4 %) and in six patients in the SAVR group (30.0 %) (p = 0.96). There was no association between the number and total volume of lesions and the occurrence of cognitive decline (CC Spearman 0.031, p = 0.85 and −0.011, p = 0.97, respectively). Conclusions TAVI and SAVR were associated with a similar rate of acute silent ischemic cerebral lesions in intermediate risk patients. Although acute lesions occurred very frequently in both strategies, their cognitive impact was not clinically relevant.
650		4	\|a Valves \|7 (dpeaa)DE-He213
650		4	\|a Catheterization \|7 (dpeaa)DE-He213
650		4	\|a Cardiac valvular surgery \|7 (dpeaa)DE-He213
650		4	\|a Stroke \|7 (dpeaa)DE-He213
650		4	\|a Magnetic resonance imaging \|7 (dpeaa)DE-He213
700	1		\|a Ferreira-Gonzalez, Ignacio \|e verfasserin \|4 aut
700	1		\|a Marsal, Josep R. \|e verfasserin \|4 aut
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700	1		\|a Auger, Cristina \|e verfasserin \|4 aut
700	1		\|a Ortega, Gemma \|e verfasserin \|4 aut
700	1		\|a Cascant, Purificación \|e verfasserin \|4 aut
700	1		\|a Urena, Marina \|e verfasserin \|4 aut
700	1		\|a Del Blanco, Bruno Garcia \|e verfasserin \|4 aut
700	1		\|a Serra, Vicenç \|e verfasserin \|4 aut
700	1		\|a Sureda, Carlos \|e verfasserin \|4 aut
700	1		\|a Igual, Albert \|e verfasserin \|4 aut
700	1		\|a Rovira, Alex \|e verfasserin \|4 aut
700	1		\|a González-Alujas, María Teresa \|e verfasserin \|4 aut
700	1		\|a Gonzalez, Anna \|e verfasserin \|4 aut
700	1		\|a Puri, Rishi \|e verfasserin \|4 aut
700	1		\|a Cuellar, Hug \|e verfasserin \|4 aut
700	1		\|a Tornos, Pilar \|e verfasserin \|4 aut
700	1		\|a Rodés-Cabau, Josep \|e verfasserin \|4 aut
700	1		\|a Garcia-Dorado, David \|e verfasserin \|4 aut
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allfields	10.1007/s00392-015-0946-9 doi (DE-627)SPR004812395 (SPR)s00392-015-0946-9-e DE-627 ger DE-627 rakwb eng 610 ASE 610 ASE 44.67 bkl 44.85 bkl Abdul-Jawad Altisent, Omar verfasserin aut Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients 2015 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background and purpose The risk of neurological damage following transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) in severe aortic stenosis patients deemed to be at intermediate surgical risk is unknown. In this target population, the degree of neurological damage was compared using brain diffusion-weighted magnetic resonance imaging (DW-MRI) and cognitive testing. Methods Forty-six consecutive patients undergoing TAVI (78.0 ± 8.3 years; STS score 4.4 ± 1.7) and 37 patients undergoing SAVR (78.9 ± 6.2 years, STS score 4.7 ± 1.7) were compared. DW-MRI was performed in 67 patients (40 in TAVI vs. 27 in SAVR group) within the first 15 days post-procedure. A cognitive assessment was performed at baseline and at 3 months follow-up. The occurrence of potential cognitive impairment post-intervention was determined using the reliable change index (RCI). Results Baseline characteristics were comparable in TAVI and SAVR groups except for the presence of severe calcified aorta, which occurred more frequently in the TAVI group [17 (37 %) vs. 0 (0 %), p < 0.001]. Three patients presented a clinical stroke: 1 (2.2 %) in TAVI group vs. 2 (5.4 %) in SAVR group, (p = 0.58). No differences were observed in the rate of acute ischemic cerebral lesions detected by DWI in patients undergoing TAVI vs. SAVR [18 (45 %) in TAVI vs. 11 (40.7 %) in SAVR, adjusted OR 0.95; 95 % CI 0.25–3.65; p = 0.94]. TAVI was associated with a lower number of DWI lesions (adjusted OR 0.54; 95 % IC 0.37–0.79; p = 0.02). An older age was a predictor of the occurrence of acute lesions (OR 1.13; 95 % CI 1.03–1.23; p = 0.01), and the use of vitamin-K antagonist therapy had a protective effect (OR 0.25; 95 % CI 0.07–0.92; p = 0.037) regardless the type of intervention. Overall no significant changes were observed in global cognitive scores post-intervention (p = 0.23). The RCI showed mild cognitive decline in nine patients undergoing TAVI (26.4 %) and in six patients in the SAVR group (30.0 %) (p = 0.96). There was no association between the number and total volume of lesions and the occurrence of cognitive decline (CC Spearman 0.031, p = 0.85 and −0.011, p = 0.97, respectively). Conclusions TAVI and SAVR were associated with a similar rate of acute silent ischemic cerebral lesions in intermediate risk patients. Although acute lesions occurred very frequently in both strategies, their cognitive impact was not clinically relevant. Valves (dpeaa)DE-He213 Catheterization (dpeaa)DE-He213 Cardiac valvular surgery (dpeaa)DE-He213 Stroke (dpeaa)DE-He213 Magnetic resonance imaging (dpeaa)DE-He213 Ferreira-Gonzalez, Ignacio verfasserin aut Marsal, Josep R. verfasserin aut Ribera, Aida verfasserin aut Auger, Cristina verfasserin aut Ortega, Gemma verfasserin aut Cascant, Purificación verfasserin aut Urena, Marina verfasserin aut Del Blanco, Bruno Garcia verfasserin aut Serra, Vicenç verfasserin aut Sureda, Carlos verfasserin aut Igual, Albert verfasserin aut Rovira, Alex verfasserin aut González-Alujas, María Teresa verfasserin aut Gonzalez, Anna verfasserin aut Puri, Rishi verfasserin aut Cuellar, Hug verfasserin aut Tornos, Pilar verfasserin aut Rodés-Cabau, Josep verfasserin aut Garcia-Dorado, David verfasserin aut Enthalten in Zeitschrift für Kardiologie Darmstadt : Steinkopff, 1997 105(2015), 6 vom: 08. Dez., Seite 508-517 (DE-627)254911137 (DE-600)1463330-9 1435-1285 nnns volume:105 year:2015 number:6 day:08 month:12 pages:508-517 https://dx.doi.org/10.1007/s00392-015-0946-9 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_152 GBV_ILN_161 GBV_ILN_171 GBV_ILN_187 GBV_ILN_224 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 44.67 ASE 44.85 ASE AR 105 2015 6 08 12 508-517
spelling	10.1007/s00392-015-0946-9 doi (DE-627)SPR004812395 (SPR)s00392-015-0946-9-e DE-627 ger DE-627 rakwb eng 610 ASE 610 ASE 44.67 bkl 44.85 bkl Abdul-Jawad Altisent, Omar verfasserin aut Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients 2015 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background and purpose The risk of neurological damage following transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) in severe aortic stenosis patients deemed to be at intermediate surgical risk is unknown. In this target population, the degree of neurological damage was compared using brain diffusion-weighted magnetic resonance imaging (DW-MRI) and cognitive testing. Methods Forty-six consecutive patients undergoing TAVI (78.0 ± 8.3 years; STS score 4.4 ± 1.7) and 37 patients undergoing SAVR (78.9 ± 6.2 years, STS score 4.7 ± 1.7) were compared. DW-MRI was performed in 67 patients (40 in TAVI vs. 27 in SAVR group) within the first 15 days post-procedure. A cognitive assessment was performed at baseline and at 3 months follow-up. The occurrence of potential cognitive impairment post-intervention was determined using the reliable change index (RCI). Results Baseline characteristics were comparable in TAVI and SAVR groups except for the presence of severe calcified aorta, which occurred more frequently in the TAVI group [17 (37 %) vs. 0 (0 %), p < 0.001]. Three patients presented a clinical stroke: 1 (2.2 %) in TAVI group vs. 2 (5.4 %) in SAVR group, (p = 0.58). No differences were observed in the rate of acute ischemic cerebral lesions detected by DWI in patients undergoing TAVI vs. SAVR [18 (45 %) in TAVI vs. 11 (40.7 %) in SAVR, adjusted OR 0.95; 95 % CI 0.25–3.65; p = 0.94]. TAVI was associated with a lower number of DWI lesions (adjusted OR 0.54; 95 % IC 0.37–0.79; p = 0.02). An older age was a predictor of the occurrence of acute lesions (OR 1.13; 95 % CI 1.03–1.23; p = 0.01), and the use of vitamin-K antagonist therapy had a protective effect (OR 0.25; 95 % CI 0.07–0.92; p = 0.037) regardless the type of intervention. Overall no significant changes were observed in global cognitive scores post-intervention (p = 0.23). The RCI showed mild cognitive decline in nine patients undergoing TAVI (26.4 %) and in six patients in the SAVR group (30.0 %) (p = 0.96). There was no association between the number and total volume of lesions and the occurrence of cognitive decline (CC Spearman 0.031, p = 0.85 and −0.011, p = 0.97, respectively). Conclusions TAVI and SAVR were associated with a similar rate of acute silent ischemic cerebral lesions in intermediate risk patients. Although acute lesions occurred very frequently in both strategies, their cognitive impact was not clinically relevant. Valves (dpeaa)DE-He213 Catheterization (dpeaa)DE-He213 Cardiac valvular surgery (dpeaa)DE-He213 Stroke (dpeaa)DE-He213 Magnetic resonance imaging (dpeaa)DE-He213 Ferreira-Gonzalez, Ignacio verfasserin aut Marsal, Josep R. verfasserin aut Ribera, Aida verfasserin aut Auger, Cristina verfasserin aut Ortega, Gemma verfasserin aut Cascant, Purificación verfasserin aut Urena, Marina verfasserin aut Del Blanco, Bruno Garcia verfasserin aut Serra, Vicenç verfasserin aut Sureda, Carlos verfasserin aut Igual, Albert verfasserin aut Rovira, Alex verfasserin aut González-Alujas, María Teresa verfasserin aut Gonzalez, Anna verfasserin aut Puri, Rishi verfasserin aut Cuellar, Hug verfasserin aut Tornos, Pilar verfasserin aut Rodés-Cabau, Josep verfasserin aut Garcia-Dorado, David verfasserin aut Enthalten in Zeitschrift für Kardiologie Darmstadt : Steinkopff, 1997 105(2015), 6 vom: 08. Dez., Seite 508-517 (DE-627)254911137 (DE-600)1463330-9 1435-1285 nnns volume:105 year:2015 number:6 day:08 month:12 pages:508-517 https://dx.doi.org/10.1007/s00392-015-0946-9 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_152 GBV_ILN_161 GBV_ILN_171 GBV_ILN_187 GBV_ILN_224 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 44.67 ASE 44.85 ASE AR 105 2015 6 08 12 508-517
allfields_unstemmed	10.1007/s00392-015-0946-9 doi (DE-627)SPR004812395 (SPR)s00392-015-0946-9-e DE-627 ger DE-627 rakwb eng 610 ASE 610 ASE 44.67 bkl 44.85 bkl Abdul-Jawad Altisent, Omar verfasserin aut Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients 2015 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background and purpose The risk of neurological damage following transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) in severe aortic stenosis patients deemed to be at intermediate surgical risk is unknown. In this target population, the degree of neurological damage was compared using brain diffusion-weighted magnetic resonance imaging (DW-MRI) and cognitive testing. Methods Forty-six consecutive patients undergoing TAVI (78.0 ± 8.3 years; STS score 4.4 ± 1.7) and 37 patients undergoing SAVR (78.9 ± 6.2 years, STS score 4.7 ± 1.7) were compared. DW-MRI was performed in 67 patients (40 in TAVI vs. 27 in SAVR group) within the first 15 days post-procedure. A cognitive assessment was performed at baseline and at 3 months follow-up. The occurrence of potential cognitive impairment post-intervention was determined using the reliable change index (RCI). Results Baseline characteristics were comparable in TAVI and SAVR groups except for the presence of severe calcified aorta, which occurred more frequently in the TAVI group [17 (37 %) vs. 0 (0 %), p < 0.001]. Three patients presented a clinical stroke: 1 (2.2 %) in TAVI group vs. 2 (5.4 %) in SAVR group, (p = 0.58). No differences were observed in the rate of acute ischemic cerebral lesions detected by DWI in patients undergoing TAVI vs. SAVR [18 (45 %) in TAVI vs. 11 (40.7 %) in SAVR, adjusted OR 0.95; 95 % CI 0.25–3.65; p = 0.94]. TAVI was associated with a lower number of DWI lesions (adjusted OR 0.54; 95 % IC 0.37–0.79; p = 0.02). An older age was a predictor of the occurrence of acute lesions (OR 1.13; 95 % CI 1.03–1.23; p = 0.01), and the use of vitamin-K antagonist therapy had a protective effect (OR 0.25; 95 % CI 0.07–0.92; p = 0.037) regardless the type of intervention. Overall no significant changes were observed in global cognitive scores post-intervention (p = 0.23). The RCI showed mild cognitive decline in nine patients undergoing TAVI (26.4 %) and in six patients in the SAVR group (30.0 %) (p = 0.96). There was no association between the number and total volume of lesions and the occurrence of cognitive decline (CC Spearman 0.031, p = 0.85 and −0.011, p = 0.97, respectively). Conclusions TAVI and SAVR were associated with a similar rate of acute silent ischemic cerebral lesions in intermediate risk patients. Although acute lesions occurred very frequently in both strategies, their cognitive impact was not clinically relevant. Valves (dpeaa)DE-He213 Catheterization (dpeaa)DE-He213 Cardiac valvular surgery (dpeaa)DE-He213 Stroke (dpeaa)DE-He213 Magnetic resonance imaging (dpeaa)DE-He213 Ferreira-Gonzalez, Ignacio verfasserin aut Marsal, Josep R. verfasserin aut Ribera, Aida verfasserin aut Auger, Cristina verfasserin aut Ortega, Gemma verfasserin aut Cascant, Purificación verfasserin aut Urena, Marina verfasserin aut Del Blanco, Bruno Garcia verfasserin aut Serra, Vicenç verfasserin aut Sureda, Carlos verfasserin aut Igual, Albert verfasserin aut Rovira, Alex verfasserin aut González-Alujas, María Teresa verfasserin aut Gonzalez, Anna verfasserin aut Puri, Rishi verfasserin aut Cuellar, Hug verfasserin aut Tornos, Pilar verfasserin aut Rodés-Cabau, Josep verfasserin aut Garcia-Dorado, David verfasserin aut Enthalten in Zeitschrift für Kardiologie Darmstadt : Steinkopff, 1997 105(2015), 6 vom: 08. Dez., Seite 508-517 (DE-627)254911137 (DE-600)1463330-9 1435-1285 nnns volume:105 year:2015 number:6 day:08 month:12 pages:508-517 https://dx.doi.org/10.1007/s00392-015-0946-9 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_152 GBV_ILN_161 GBV_ILN_171 GBV_ILN_187 GBV_ILN_224 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 44.67 ASE 44.85 ASE AR 105 2015 6 08 12 508-517
allfieldsGer	10.1007/s00392-015-0946-9 doi (DE-627)SPR004812395 (SPR)s00392-015-0946-9-e DE-627 ger DE-627 rakwb eng 610 ASE 610 ASE 44.67 bkl 44.85 bkl Abdul-Jawad Altisent, Omar verfasserin aut Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients 2015 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background and purpose The risk of neurological damage following transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) in severe aortic stenosis patients deemed to be at intermediate surgical risk is unknown. In this target population, the degree of neurological damage was compared using brain diffusion-weighted magnetic resonance imaging (DW-MRI) and cognitive testing. Methods Forty-six consecutive patients undergoing TAVI (78.0 ± 8.3 years; STS score 4.4 ± 1.7) and 37 patients undergoing SAVR (78.9 ± 6.2 years, STS score 4.7 ± 1.7) were compared. DW-MRI was performed in 67 patients (40 in TAVI vs. 27 in SAVR group) within the first 15 days post-procedure. A cognitive assessment was performed at baseline and at 3 months follow-up. The occurrence of potential cognitive impairment post-intervention was determined using the reliable change index (RCI). Results Baseline characteristics were comparable in TAVI and SAVR groups except for the presence of severe calcified aorta, which occurred more frequently in the TAVI group [17 (37 %) vs. 0 (0 %), p < 0.001]. Three patients presented a clinical stroke: 1 (2.2 %) in TAVI group vs. 2 (5.4 %) in SAVR group, (p = 0.58). No differences were observed in the rate of acute ischemic cerebral lesions detected by DWI in patients undergoing TAVI vs. SAVR [18 (45 %) in TAVI vs. 11 (40.7 %) in SAVR, adjusted OR 0.95; 95 % CI 0.25–3.65; p = 0.94]. TAVI was associated with a lower number of DWI lesions (adjusted OR 0.54; 95 % IC 0.37–0.79; p = 0.02). An older age was a predictor of the occurrence of acute lesions (OR 1.13; 95 % CI 1.03–1.23; p = 0.01), and the use of vitamin-K antagonist therapy had a protective effect (OR 0.25; 95 % CI 0.07–0.92; p = 0.037) regardless the type of intervention. Overall no significant changes were observed in global cognitive scores post-intervention (p = 0.23). The RCI showed mild cognitive decline in nine patients undergoing TAVI (26.4 %) and in six patients in the SAVR group (30.0 %) (p = 0.96). There was no association between the number and total volume of lesions and the occurrence of cognitive decline (CC Spearman 0.031, p = 0.85 and −0.011, p = 0.97, respectively). Conclusions TAVI and SAVR were associated with a similar rate of acute silent ischemic cerebral lesions in intermediate risk patients. Although acute lesions occurred very frequently in both strategies, their cognitive impact was not clinically relevant. Valves (dpeaa)DE-He213 Catheterization (dpeaa)DE-He213 Cardiac valvular surgery (dpeaa)DE-He213 Stroke (dpeaa)DE-He213 Magnetic resonance imaging (dpeaa)DE-He213 Ferreira-Gonzalez, Ignacio verfasserin aut Marsal, Josep R. verfasserin aut Ribera, Aida verfasserin aut Auger, Cristina verfasserin aut Ortega, Gemma verfasserin aut Cascant, Purificación verfasserin aut Urena, Marina verfasserin aut Del Blanco, Bruno Garcia verfasserin aut Serra, Vicenç verfasserin aut Sureda, Carlos verfasserin aut Igual, Albert verfasserin aut Rovira, Alex verfasserin aut González-Alujas, María Teresa verfasserin aut Gonzalez, Anna verfasserin aut Puri, Rishi verfasserin aut Cuellar, Hug verfasserin aut Tornos, Pilar verfasserin aut Rodés-Cabau, Josep verfasserin aut Garcia-Dorado, David verfasserin aut Enthalten in Zeitschrift für Kardiologie Darmstadt : Steinkopff, 1997 105(2015), 6 vom: 08. Dez., Seite 508-517 (DE-627)254911137 (DE-600)1463330-9 1435-1285 nnns volume:105 year:2015 number:6 day:08 month:12 pages:508-517 https://dx.doi.org/10.1007/s00392-015-0946-9 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_152 GBV_ILN_161 GBV_ILN_171 GBV_ILN_187 GBV_ILN_224 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 44.67 ASE 44.85 ASE AR 105 2015 6 08 12 508-517
allfieldsSound	10.1007/s00392-015-0946-9 doi (DE-627)SPR004812395 (SPR)s00392-015-0946-9-e DE-627 ger DE-627 rakwb eng 610 ASE 610 ASE 44.67 bkl 44.85 bkl Abdul-Jawad Altisent, Omar verfasserin aut Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients 2015 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background and purpose The risk of neurological damage following transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) in severe aortic stenosis patients deemed to be at intermediate surgical risk is unknown. In this target population, the degree of neurological damage was compared using brain diffusion-weighted magnetic resonance imaging (DW-MRI) and cognitive testing. Methods Forty-six consecutive patients undergoing TAVI (78.0 ± 8.3 years; STS score 4.4 ± 1.7) and 37 patients undergoing SAVR (78.9 ± 6.2 years, STS score 4.7 ± 1.7) were compared. DW-MRI was performed in 67 patients (40 in TAVI vs. 27 in SAVR group) within the first 15 days post-procedure. A cognitive assessment was performed at baseline and at 3 months follow-up. The occurrence of potential cognitive impairment post-intervention was determined using the reliable change index (RCI). Results Baseline characteristics were comparable in TAVI and SAVR groups except for the presence of severe calcified aorta, which occurred more frequently in the TAVI group [17 (37 %) vs. 0 (0 %), p < 0.001]. Three patients presented a clinical stroke: 1 (2.2 %) in TAVI group vs. 2 (5.4 %) in SAVR group, (p = 0.58). No differences were observed in the rate of acute ischemic cerebral lesions detected by DWI in patients undergoing TAVI vs. SAVR [18 (45 %) in TAVI vs. 11 (40.7 %) in SAVR, adjusted OR 0.95; 95 % CI 0.25–3.65; p = 0.94]. TAVI was associated with a lower number of DWI lesions (adjusted OR 0.54; 95 % IC 0.37–0.79; p = 0.02). An older age was a predictor of the occurrence of acute lesions (OR 1.13; 95 % CI 1.03–1.23; p = 0.01), and the use of vitamin-K antagonist therapy had a protective effect (OR 0.25; 95 % CI 0.07–0.92; p = 0.037) regardless the type of intervention. Overall no significant changes were observed in global cognitive scores post-intervention (p = 0.23). The RCI showed mild cognitive decline in nine patients undergoing TAVI (26.4 %) and in six patients in the SAVR group (30.0 %) (p = 0.96). There was no association between the number and total volume of lesions and the occurrence of cognitive decline (CC Spearman 0.031, p = 0.85 and −0.011, p = 0.97, respectively). Conclusions TAVI and SAVR were associated with a similar rate of acute silent ischemic cerebral lesions in intermediate risk patients. Although acute lesions occurred very frequently in both strategies, their cognitive impact was not clinically relevant. Valves (dpeaa)DE-He213 Catheterization (dpeaa)DE-He213 Cardiac valvular surgery (dpeaa)DE-He213 Stroke (dpeaa)DE-He213 Magnetic resonance imaging (dpeaa)DE-He213 Ferreira-Gonzalez, Ignacio verfasserin aut Marsal, Josep R. verfasserin aut Ribera, Aida verfasserin aut Auger, Cristina verfasserin aut Ortega, Gemma verfasserin aut Cascant, Purificación verfasserin aut Urena, Marina verfasserin aut Del Blanco, Bruno Garcia verfasserin aut Serra, Vicenç verfasserin aut Sureda, Carlos verfasserin aut Igual, Albert verfasserin aut Rovira, Alex verfasserin aut González-Alujas, María Teresa verfasserin aut Gonzalez, Anna verfasserin aut Puri, Rishi verfasserin aut Cuellar, Hug verfasserin aut Tornos, Pilar verfasserin aut Rodés-Cabau, Josep verfasserin aut Garcia-Dorado, David verfasserin aut Enthalten in Zeitschrift für Kardiologie Darmstadt : Steinkopff, 1997 105(2015), 6 vom: 08. Dez., Seite 508-517 (DE-627)254911137 (DE-600)1463330-9 1435-1285 nnns volume:105 year:2015 number:6 day:08 month:12 pages:508-517 https://dx.doi.org/10.1007/s00392-015-0946-9 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_152 GBV_ILN_161 GBV_ILN_171 GBV_ILN_187 GBV_ILN_224 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 44.67 ASE 44.85 ASE AR 105 2015 6 08 12 508-517
language	English
source	Enthalten in Zeitschrift für Kardiologie 105(2015), 6 vom: 08. Dez., Seite 508-517 volume:105 year:2015 number:6 day:08 month:12 pages:508-517
sourceStr	Enthalten in Zeitschrift für Kardiologie 105(2015), 6 vom: 08. Dez., Seite 508-517 volume:105 year:2015 number:6 day:08 month:12 pages:508-517
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	Valves Catheterization Cardiac valvular surgery Stroke Magnetic resonance imaging
dewey-raw	610
isfreeaccess_bool	false
container_title	Zeitschrift für Kardiologie
authorswithroles_txt_mv	Abdul-Jawad Altisent, Omar @@aut@@ Ferreira-Gonzalez, Ignacio @@aut@@ Marsal, Josep R. @@aut@@ Ribera, Aida @@aut@@ Auger, Cristina @@aut@@ Ortega, Gemma @@aut@@ Cascant, Purificación @@aut@@ Urena, Marina @@aut@@ Del Blanco, Bruno Garcia @@aut@@ Serra, Vicenç @@aut@@ Sureda, Carlos @@aut@@ Igual, Albert @@aut@@ Rovira, Alex @@aut@@ González-Alujas, María Teresa @@aut@@ Gonzalez, Anna @@aut@@ Puri, Rishi @@aut@@ Cuellar, Hug @@aut@@ Tornos, Pilar @@aut@@ Rodés-Cabau, Josep @@aut@@ Garcia-Dorado, David @@aut@@
publishDateDaySort_date	2015-12-08T00:00:00Z
hierarchy_top_id	254911137
dewey-sort	3610
id	SPR004812395
language_de	englisch
fullrecord	<?xml version="1.0" encoding="UTF-8"?><collection xmlns="http://www.loc.gov/MARC21/slim"><record><leader>01000caa a22002652 4500</leader><controlfield tag="001">SPR004812395</controlfield><controlfield tag="003">DE-627</controlfield><controlfield tag="005">20230519112420.0</controlfield><controlfield tag="007">cr uuu---uuuuu</controlfield><controlfield tag="008">201001s2015 xx \|\|\|\|\|o 00\| \|\|eng c</controlfield><datafield tag="024" ind1="7" ind2=" "><subfield code="a">10.1007/s00392-015-0946-9</subfield><subfield code="2">doi</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-627)SPR004812395</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(SPR)s00392-015-0946-9-e</subfield></datafield><datafield tag="040" ind1=" " ind2=" "><subfield code="a">DE-627</subfield><subfield code="b">ger</subfield><subfield code="c">DE-627</subfield><subfield code="e">rakwb</subfield></datafield><datafield tag="041" ind1=" " ind2=" "><subfield code="a">eng</subfield></datafield><datafield tag="082" ind1="0" ind2="4"><subfield code="a">610</subfield><subfield code="q">ASE</subfield></datafield><datafield tag="082" ind1="0" ind2="4"><subfield code="a">610</subfield><subfield code="q">ASE</subfield></datafield><datafield tag="084" ind1=" " ind2=" "><subfield code="a">44.67</subfield><subfield code="2">bkl</subfield></datafield><datafield tag="084" ind1=" " ind2=" "><subfield code="a">44.85</subfield><subfield code="2">bkl</subfield></datafield><datafield tag="100" ind1="1" ind2=" "><subfield code="a">Abdul-Jawad Altisent, Omar</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="245" ind1="1" ind2="0"><subfield code="a">Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients</subfield></datafield><datafield tag="264" ind1=" " ind2="1"><subfield code="c">2015</subfield></datafield><datafield tag="336" ind1=" " ind2=" "><subfield code="a">Text</subfield><subfield code="b">txt</subfield><subfield code="2">rdacontent</subfield></datafield><datafield tag="337" ind1=" " ind2=" "><subfield code="a">Computermedien</subfield><subfield code="b">c</subfield><subfield code="2">rdamedia</subfield></datafield><datafield tag="338" ind1=" " ind2=" "><subfield code="a">Online-Ressource</subfield><subfield code="b">cr</subfield><subfield code="2">rdacarrier</subfield></datafield><datafield tag="520" ind1=" " ind2=" "><subfield code="a">Background and purpose The risk of neurological damage following transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) in severe aortic stenosis patients deemed to be at intermediate surgical risk is unknown. In this target population, the degree of neurological damage was compared using brain diffusion-weighted magnetic resonance imaging (DW-MRI) and cognitive testing. Methods Forty-six consecutive patients undergoing TAVI (78.0 ± 8.3 years; STS score 4.4 ± 1.7) and 37 patients undergoing SAVR (78.9 ± 6.2 years, STS score 4.7 ± 1.7) were compared. DW-MRI was performed in 67 patients (40 in TAVI vs. 27 in SAVR group) within the first 15 days post-procedure. A cognitive assessment was performed at baseline and at 3 months follow-up. The occurrence of potential cognitive impairment post-intervention was determined using the reliable change index (RCI). Results Baseline characteristics were comparable in TAVI and SAVR groups except for the presence of severe calcified aorta, which occurred more frequently in the TAVI group [17 (37 %) vs. 0 (0 %), p < 0.001]. Three patients presented a clinical stroke: 1 (2.2 %) in TAVI group vs. 2 (5.4 %) in SAVR group, (p = 0.58). No differences were observed in the rate of acute ischemic cerebral lesions detected by DWI in patients undergoing TAVI vs. SAVR [18 (45 %) in TAVI vs. 11 (40.7 %) in SAVR, adjusted OR 0.95; 95 % CI 0.25–3.65; p = 0.94]. TAVI was associated with a lower number of DWI lesions (adjusted OR 0.54; 95 % IC 0.37–0.79; p = 0.02). An older age was a predictor of the occurrence of acute lesions (OR 1.13; 95 % CI 1.03–1.23; p = 0.01), and the use of vitamin-K antagonist therapy had a protective effect (OR 0.25; 95 % CI 0.07–0.92; p = 0.037) regardless the type of intervention. Overall no significant changes were observed in global cognitive scores post-intervention (p = 0.23). The RCI showed mild cognitive decline in nine patients undergoing TAVI (26.4 %) and in six patients in the SAVR group (30.0 %) (p = 0.96). There was no association between the number and total volume of lesions and the occurrence of cognitive decline (CC Spearman 0.031, p = 0.85 and −0.011, p = 0.97, respectively). Conclusions TAVI and SAVR were associated with a similar rate of acute silent ischemic cerebral lesions in intermediate risk patients. 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author	Abdul-Jawad Altisent, Omar
spellingShingle	Abdul-Jawad Altisent, Omar ddc 610 bkl 44.67 bkl 44.85 misc Valves misc Catheterization misc Cardiac valvular surgery misc Stroke misc Magnetic resonance imaging Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients
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topic_title	610 ASE 44.67 bkl 44.85 bkl Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients Valves (dpeaa)DE-He213 Catheterization (dpeaa)DE-He213 Cardiac valvular surgery (dpeaa)DE-He213 Stroke (dpeaa)DE-He213 Magnetic resonance imaging (dpeaa)DE-He213
topic	ddc 610 bkl 44.67 bkl 44.85 misc Valves misc Catheterization misc Cardiac valvular surgery misc Stroke misc Magnetic resonance imaging
topic_unstemmed	ddc 610 bkl 44.67 bkl 44.85 misc Valves misc Catheterization misc Cardiac valvular surgery misc Stroke misc Magnetic resonance imaging
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title	Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients
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title_full	Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients
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author_browse	Abdul-Jawad Altisent, Omar Ferreira-Gonzalez, Ignacio Marsal, Josep R. Ribera, Aida Auger, Cristina Ortega, Gemma Cascant, Purificación Urena, Marina Del Blanco, Bruno Garcia Serra, Vicenç Sureda, Carlos Igual, Albert Rovira, Alex González-Alujas, María Teresa Gonzalez, Anna Puri, Rishi Cuellar, Hug Tornos, Pilar Rodés-Cabau, Josep Garcia-Dorado, David
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title_sort	neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients
title_auth	Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients
abstract	Background and purpose The risk of neurological damage following transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) in severe aortic stenosis patients deemed to be at intermediate surgical risk is unknown. In this target population, the degree of neurological damage was compared using brain diffusion-weighted magnetic resonance imaging (DW-MRI) and cognitive testing. Methods Forty-six consecutive patients undergoing TAVI (78.0 ± 8.3 years; STS score 4.4 ± 1.7) and 37 patients undergoing SAVR (78.9 ± 6.2 years, STS score 4.7 ± 1.7) were compared. DW-MRI was performed in 67 patients (40 in TAVI vs. 27 in SAVR group) within the first 15 days post-procedure. A cognitive assessment was performed at baseline and at 3 months follow-up. The occurrence of potential cognitive impairment post-intervention was determined using the reliable change index (RCI). Results Baseline characteristics were comparable in TAVI and SAVR groups except for the presence of severe calcified aorta, which occurred more frequently in the TAVI group [17 (37 %) vs. 0 (0 %), p < 0.001]. Three patients presented a clinical stroke: 1 (2.2 %) in TAVI group vs. 2 (5.4 %) in SAVR group, (p = 0.58). No differences were observed in the rate of acute ischemic cerebral lesions detected by DWI in patients undergoing TAVI vs. SAVR [18 (45 %) in TAVI vs. 11 (40.7 %) in SAVR, adjusted OR 0.95; 95 % CI 0.25–3.65; p = 0.94]. TAVI was associated with a lower number of DWI lesions (adjusted OR 0.54; 95 % IC 0.37–0.79; p = 0.02). An older age was a predictor of the occurrence of acute lesions (OR 1.13; 95 % CI 1.03–1.23; p = 0.01), and the use of vitamin-K antagonist therapy had a protective effect (OR 0.25; 95 % CI 0.07–0.92; p = 0.037) regardless the type of intervention. Overall no significant changes were observed in global cognitive scores post-intervention (p = 0.23). The RCI showed mild cognitive decline in nine patients undergoing TAVI (26.4 %) and in six patients in the SAVR group (30.0 %) (p = 0.96). There was no association between the number and total volume of lesions and the occurrence of cognitive decline (CC Spearman 0.031, p = 0.85 and −0.011, p = 0.97, respectively). Conclusions TAVI and SAVR were associated with a similar rate of acute silent ischemic cerebral lesions in intermediate risk patients. Although acute lesions occurred very frequently in both strategies, their cognitive impact was not clinically relevant.
abstractGer	Background and purpose The risk of neurological damage following transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) in severe aortic stenosis patients deemed to be at intermediate surgical risk is unknown. In this target population, the degree of neurological damage was compared using brain diffusion-weighted magnetic resonance imaging (DW-MRI) and cognitive testing. Methods Forty-six consecutive patients undergoing TAVI (78.0 ± 8.3 years; STS score 4.4 ± 1.7) and 37 patients undergoing SAVR (78.9 ± 6.2 years, STS score 4.7 ± 1.7) were compared. DW-MRI was performed in 67 patients (40 in TAVI vs. 27 in SAVR group) within the first 15 days post-procedure. A cognitive assessment was performed at baseline and at 3 months follow-up. The occurrence of potential cognitive impairment post-intervention was determined using the reliable change index (RCI). Results Baseline characteristics were comparable in TAVI and SAVR groups except for the presence of severe calcified aorta, which occurred more frequently in the TAVI group [17 (37 %) vs. 0 (0 %), p < 0.001]. Three patients presented a clinical stroke: 1 (2.2 %) in TAVI group vs. 2 (5.4 %) in SAVR group, (p = 0.58). No differences were observed in the rate of acute ischemic cerebral lesions detected by DWI in patients undergoing TAVI vs. SAVR [18 (45 %) in TAVI vs. 11 (40.7 %) in SAVR, adjusted OR 0.95; 95 % CI 0.25–3.65; p = 0.94]. TAVI was associated with a lower number of DWI lesions (adjusted OR 0.54; 95 % IC 0.37–0.79; p = 0.02). An older age was a predictor of the occurrence of acute lesions (OR 1.13; 95 % CI 1.03–1.23; p = 0.01), and the use of vitamin-K antagonist therapy had a protective effect (OR 0.25; 95 % CI 0.07–0.92; p = 0.037) regardless the type of intervention. Overall no significant changes were observed in global cognitive scores post-intervention (p = 0.23). The RCI showed mild cognitive decline in nine patients undergoing TAVI (26.4 %) and in six patients in the SAVR group (30.0 %) (p = 0.96). There was no association between the number and total volume of lesions and the occurrence of cognitive decline (CC Spearman 0.031, p = 0.85 and −0.011, p = 0.97, respectively). Conclusions TAVI and SAVR were associated with a similar rate of acute silent ischemic cerebral lesions in intermediate risk patients. Although acute lesions occurred very frequently in both strategies, their cognitive impact was not clinically relevant.
abstract_unstemmed	Background and purpose The risk of neurological damage following transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) in severe aortic stenosis patients deemed to be at intermediate surgical risk is unknown. In this target population, the degree of neurological damage was compared using brain diffusion-weighted magnetic resonance imaging (DW-MRI) and cognitive testing. Methods Forty-six consecutive patients undergoing TAVI (78.0 ± 8.3 years; STS score 4.4 ± 1.7) and 37 patients undergoing SAVR (78.9 ± 6.2 years, STS score 4.7 ± 1.7) were compared. DW-MRI was performed in 67 patients (40 in TAVI vs. 27 in SAVR group) within the first 15 days post-procedure. A cognitive assessment was performed at baseline and at 3 months follow-up. The occurrence of potential cognitive impairment post-intervention was determined using the reliable change index (RCI). Results Baseline characteristics were comparable in TAVI and SAVR groups except for the presence of severe calcified aorta, which occurred more frequently in the TAVI group [17 (37 %) vs. 0 (0 %), p < 0.001]. Three patients presented a clinical stroke: 1 (2.2 %) in TAVI group vs. 2 (5.4 %) in SAVR group, (p = 0.58). No differences were observed in the rate of acute ischemic cerebral lesions detected by DWI in patients undergoing TAVI vs. SAVR [18 (45 %) in TAVI vs. 11 (40.7 %) in SAVR, adjusted OR 0.95; 95 % CI 0.25–3.65; p = 0.94]. TAVI was associated with a lower number of DWI lesions (adjusted OR 0.54; 95 % IC 0.37–0.79; p = 0.02). An older age was a predictor of the occurrence of acute lesions (OR 1.13; 95 % CI 1.03–1.23; p = 0.01), and the use of vitamin-K antagonist therapy had a protective effect (OR 0.25; 95 % CI 0.07–0.92; p = 0.037) regardless the type of intervention. Overall no significant changes were observed in global cognitive scores post-intervention (p = 0.23). The RCI showed mild cognitive decline in nine patients undergoing TAVI (26.4 %) and in six patients in the SAVR group (30.0 %) (p = 0.96). There was no association between the number and total volume of lesions and the occurrence of cognitive decline (CC Spearman 0.031, p = 0.85 and −0.011, p = 0.97, respectively). Conclusions TAVI and SAVR were associated with a similar rate of acute silent ischemic cerebral lesions in intermediate risk patients. Although acute lesions occurred very frequently in both strategies, their cognitive impact was not clinically relevant.
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title_short	Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients
url	https://dx.doi.org/10.1007/s00392-015-0946-9
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author2	Ferreira-Gonzalez, Ignacio Marsal, Josep R. Ribera, Aida Auger, Cristina Ortega, Gemma Cascant, Purificación Urena, Marina Del Blanco, Bruno Garcia Serra, Vicenç Sureda, Carlos Igual, Albert Rovira, Alex González-Alujas, María Teresa Gonzalez, Anna Puri, Rishi Cuellar, Hug Tornos, Pilar Rodés-Cabau, Josep Garcia-Dorado, David
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In this target population, the degree of neurological damage was compared using brain diffusion-weighted magnetic resonance imaging (DW-MRI) and cognitive testing. Methods Forty-six consecutive patients undergoing TAVI (78.0 ± 8.3 years; STS score 4.4 ± 1.7) and 37 patients undergoing SAVR (78.9 ± 6.2 years, STS score 4.7 ± 1.7) were compared. DW-MRI was performed in 67 patients (40 in TAVI vs. 27 in SAVR group) within the first 15 days post-procedure. A cognitive assessment was performed at baseline and at 3 months follow-up. The occurrence of potential cognitive impairment post-intervention was determined using the reliable change index (RCI). Results Baseline characteristics were comparable in TAVI and SAVR groups except for the presence of severe calcified aorta, which occurred more frequently in the TAVI group [17 (37 %) vs. 0 (0 %), p < 0.001]. Three patients presented a clinical stroke: 1 (2.2 %) in TAVI group vs. 2 (5.4 %) in SAVR group, (p = 0.58). No differences were observed in the rate of acute ischemic cerebral lesions detected by DWI in patients undergoing TAVI vs. SAVR [18 (45 %) in TAVI vs. 11 (40.7 %) in SAVR, adjusted OR 0.95; 95 % CI 0.25–3.65; p = 0.94]. TAVI was associated with a lower number of DWI lesions (adjusted OR 0.54; 95 % IC 0.37–0.79; p = 0.02). An older age was a predictor of the occurrence of acute lesions (OR 1.13; 95 % CI 1.03–1.23; p = 0.01), and the use of vitamin-K antagonist therapy had a protective effect (OR 0.25; 95 % CI 0.07–0.92; p = 0.037) regardless the type of intervention. Overall no significant changes were observed in global cognitive scores post-intervention (p = 0.23). The RCI showed mild cognitive decline in nine patients undergoing TAVI (26.4 %) and in six patients in the SAVR group (30.0 %) (p = 0.96). There was no association between the number and total volume of lesions and the occurrence of cognitive decline (CC Spearman 0.031, p = 0.85 and −0.011, p = 0.97, respectively). Conclusions TAVI and SAVR were associated with a similar rate of acute silent ischemic cerebral lesions in intermediate risk patients. 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Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients

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