Silent cerebral infarction and cognitive function following TAVI: an observational two-centre UK comparison of the first-generation CoreValve and second-generation Lotus valve

Al Musa, T., Uddin, A., Loveday, C., Dobson, L.E., Igra, M., Richards, F., Swoboda, P.P., Singh, A., Garg, P., Foley, J.R.J., Fent, G.J., Goddard, A.J.P., Malkin, C., Plein, S., Blackman, D.J., McCann, G.P. and Greenwood, J.P. 2019. Silent cerebral infarction and cognitive function following TAVI: an observational two-centre UK comparison of the first-generation CoreValve and second-generation Lotus valve. BMJ Open. 9 (e022329).

TitleSilent cerebral infarction and cognitive function following TAVI: an observational two-centre UK comparison of the first-generation CoreValve and second-generation Lotus valve
TypeJournal article
AuthorsAl Musa, T., Uddin, A., Loveday, C., Dobson, L.E., Igra, M., Richards, F., Swoboda, P.P., Singh, A., Garg, P., Foley, J.R.J., Fent, G.J., Goddard, A.J.P., Malkin, C., Plein, S., Blackman, D.J., McCann, G.P. and Greenwood, J.P.
Abstract

Objective To compare the incidence of silent cerebral infarction and impact on cognitive function following transcatheter aortic valve implantation (TAVI) with the first-generation CoreValve (Medtronic, Minneapolis, Minnesota, USA) and second-generation Lotus valve (Boston Scientific, Natick Massachusetts, USA).

Design A prospective observational study comprising a 1.5 T cerebral MRI scan, performed preoperatively and immediately following TAVI, and neurocognitive assessments performed at baseline, 30 days and 1 year follow-up.

Setting University hospitals of Leeds and Leicester, UK.

Patients 66 (80.6±8.0 years, 47% male) patients with high-risk severe symptomatic aortic stenosis recruited between April 2012 and May 2015.

Main outcome measures Incidence of new cerebral microinfarction and objective decline in neurocognitive performance.

Results All underwent cerebral MRI at baseline and immediately following TAVI, and 49 (25 Lotus, 24 CoreValve) completed neurocognitive assessments at baseline, 30 days and 1 year. There was a significantly greater incidence of new cerebral microinfarction observed following the Lotus TAVI (23 (79%) vs 22 (59%), p=0.025) with a greater number of new infarcts per patient (median 3.5 (IQR 7.0) vs 2.0 (IQR 3.0), p=0.002). The mean volume of infarcted cerebral tissue per patient was equivalent following the two prostheses (p=0.166). More patients suffered new anterior (14 (48%) vs 2 (5%), p=0.001) and vertebrobasilar (15 (52%) vs 7 (19%), p=0.005) lesions following Lotus. Lotus was associated with a decline in verbal memory and psychomotor speed at 30 days. However, performance longitudinally at 1 year was preserved in all neurocognitive domains.

Conclusions There was a higher incidence of silent cerebral microinfarction and a greater number of lesions per patient following Lotus compared with CoreValve. However, there was no objective decline in neurocognitive function discernible at 1 year following TAVI with either prosthesis.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial.

JournalBMJ Open
Journal citation9 (e022329)
ISSN2044-6055
Year2019
PublisherBMJ
Publisher's versione022329.full.pdf
Digital Object Identifier (DOI)doi:10.1136/bmjopen-2018-022329
Web address (URL)https://bmjopen.bmj.com/content/9/1/e022329
Publication dates
Published21 Jan 2019
LicenseCC BY-NC 4.0

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