Transcranial Doppler-detected cerebral embolic load during transcatheter aortic valve implantation.
نویسندگان
چکیده
OBJECTIVES Transcatheter aortic valve implantation (TAVI) is an alternative to surgery for high-risk patients with severe aortic valve stenosis. Periprocedural stroke is reported at an incidence up to 10%. Magnetic resonance imaging studies have identified new onset of clinically silent ischaemic cerebral lesions more frequently (68-84%). So far, few data are available about cerebral embolism during TAVI. The aim of this study was to determine the frequency of high-intensity transient signals (HITS) and to explore differences in the HITS pattern between transfemoral and transapical access and between self-expanding (SE) and balloon-expandable (BE) deployment technique. METHODS Transcranial Doppler (TCD) ultrasound recordings of 44 patients undergoing TAVI (age 78 ± 6 years; logistic EuroSCORE 28 ± 15%; transfemoral access, n = 32; transapical access, n = 12; SE, n = 27; BE, n = 17) were analysed for HITS during the following intervals: (i) instrumentation prior to valvuloplasty, (ii) balloon valvuloplasty, (iii) prosthesis deployment (DP) and (iv) post-implantation (PI) including any re-dilatation episodes. The total procedural load of HITS and HITS frequency in procedural intervals were compared between different access routes and DP techniques. Periprocedural neurocognitive impairment was assessed clinically and by the confusion assessment method (CAM) prior to TAVI and on post-procedural days 1 and 4-6. RESULTS TCD recordings demonstrated the occurrence of HITS in all patients. DP was associated with the highest load of HITS. Access route did not significantly influence the total burden of periprocedural HITS. During procedures using the SE type, a slightly larger total load of HITS was observed than with the BE type (P = 0.024). This was mainly due to more HITS during the DP (P = 0.027) and the PI interval (P = 0.002). No incidence of delirium was detected by CAM ratings. Two patients suffered a new onset of stroke within the 2 weeks following the procedure. In-hospital death and 30-day mortality were 0/44. CONCLUSIONS HITS are observed during all procedural intervals in TAVI. The embolic events appear to peak during DP. In our series, the overall cerebral embolic load did not differ between the transfemoral and the transapical access route. TCD monitoring in TAVI is useful to identify periods and manipulations associated with an increased cerebral embolic load and may help to further enhance the safety of this procedure.
منابع مشابه
Cerebral embolization during transcatheter aortic valve implantation: a transcranial Doppler study.
BACKGROUND Transcatheter aortic valve implantation (TAVI) is associated with a higher risk of neurological events for both the transfemoral and transapical approach than surgical valve replacement. Cerebral magnetic resonance imaging has revealed more new, albeit clinically silent lesions from procedural embolization, yet the main source and predominant procedural step of emboli remain unclear....
متن کاملStroke Cerebral Embolization During Transcatheter Aortic Valve Implantation A Transcranial Doppler Study
Background—Transcatheter aortic valve implantation (TAVI) is associated with a higher risk of neurological events for both the transfemoral and transapical approach than surgical valve replacement. Cerebral magnetic resonance imaging has revealed more new, albeit clinically silent lesions from procedural embolization, yet the main source and predominant procedural step of emboli remain unclear....
متن کاملThe Self-Expanding Symetis Acurate Does Not Increase Cerebral Microembolic Load When Compared to the Balloon-Expandable Edwards Sapien Prosthesis: A Transcranial Doppler Study in Patients Undergoing Transapical Aortic Valve Implantation
OBJECTIVES The aim of this study was to quantify potential differences in count, frequency and pattern of high-intensity transient signals (HITS) during transapical transcatheter aortic valve implantation (TA-TAVI), by comparing the Symetis Acurate TA (SA) with the balloon-expandable Edwards Sapien XT (ES) system. BACKGROUND Recently, the Symetis Acurate TA revalving system has been introduce...
متن کاملCerebral embolization during transcatheter aortic valve implantation.
The recent success of transcatheter aortic valve implantation (TAVI) has been associated with a heightened awareness of the potential risks, particularly stroke. Recent meta-analyses report 30-day stroke rates of 3% to 4%,1,2 and diffusion-weighted MRI studies have revealed new, clinically silent, cerebral lesions in 68% to 84% of patients undergoing TAVI.3–5 Although the majority of patients u...
متن کاملResponse to letters regarding article, “cerebral embolization during transcatheter aortic valve implantation: a transcranial Doppler study”.
The importance of cerebral embolization as the main cause of periprocedural stroke during transcatheter aortic valve implanta-tion has recently been demonstrated. Erdoes and colleagues 1 have reported high-intensity transient signals as surrogates for micro-emboli during all phases of the procedure, predominantly during valve implantation, with no difference between transfemoral and transapical...
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عنوان ژورنال:
- European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
دوره 41 4 شماره
صفحات -
تاریخ انتشار 2012