title: Embolic cerebral insults after transapical aortic valve implantation detected by magnetic resonance imaging.
abstract: OBJECTIVE
  This study assessed the rate of periprocedural embolic ischemic brain injury during transapical aortic valve replacement in 25 consecutive patients.
  
  
  BACKGROUND
  Transcatheter aortic valve implantation is rapidly being established as a new therapeutic approach for aortic valve stenosis. Although initial clinical results are promising, it is unknown whether mobilization and embolization of calcified particles may lead to cerebral ischemia.
  
  
  METHODS
  Twenty-five consecutive patients (10 men, 15 women, mean age: 81 ± 5 years, mean log EuroSCORE [European System for Cardiac Operative Risk Evaluation]: 32 ± 10%) scheduled for transapical aortic valve implantation were included. All patients received a baseline cerebral magnetic resonance imaging scan. The scan was repeated approximately 6 days after valve implantation. The magnetic resonance imaging studies included axial diffusion-weighted, T(2)-weighted, fluid attenuated inversion recovery-weighted, and T(2) gradient echo sequences. Standardized assessment of the neurologic status was performed before aortic valve replacement and post-operatively.
  
  
  RESULTS
  Transapical aortic valve implantation was successfully performed in all patients. In 17 patients (68%), new cerebral lesions could be detected, whereas 8 patients showed no new cerebral insults. The pattern of distribution and morphology were typical of embolic origin. Despite the high incidence of morphologically detectable lesions, only 5 patients showed clinical neurologic alterations. Out of these patients, only 1 suffered from a permanent stroke.
  
  
  CONCLUSIONS
  New embolic ischemic cerebral insults are detected in 68% of patients after transapical valve implantation. Clinical symptoms are rare and usually transitory. Larger trials will need to establish the clinical significance of asymptomatic ischemic lesions as well as the rate of ischemic events in patients undergoing transfemoral valve replacement.
authors.affiliation: Department of Cardiology, University Hospital Erlangen, Erlangen, Germany. martin.arnold@uk-erlangen.de
authors.forename: Martin
authors.initials: M
authors.lastname: Arnold
authors.forename: Susanne
authors.initials: S
authors.lastname: Schulz-Heise
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.forename: Sabine
authors.initials: S
authors.lastname: Ott
authors.forename: Arnd
authors.initials: A
authors.lastname: Dörfler
authors.forename: Dieter
authors.initials: D
authors.lastname: Ropers
authors.forename: Richard
authors.initials: R
authors.lastname: Feyrer
authors.forename: Friedrich
authors.initials: F
authors.lastname: Einhaus
authors.forename: Sabrina
authors.initials: S
authors.lastname: Loders
authors.forename: Faidi
authors.initials: F
authors.lastname: Mahmoud
authors.forename: Olaf
authors.initials: O
authors.lastname: Roerick
authors.forename: Werner G
authors.initials: WG
authors.lastname: Daniel
authors.forename: Michael
authors.initials: M
authors.lastname: Weyand
authors.forename: Stephan M
authors.initials: SM
authors.lastname: Ensminger
authors.forename: Josef
authors.initials: J
authors.lastname: Ludwig
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000628:therapy*; D002545:Brain Ischemia / Q000175:diagnosis* / Q000209:etiology; D006328:Cardiac Catheterization / Q000009:adverse effects*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005858:Germany; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D009460:Neurologic Examination; D011237:Predictive Value of Tests; D020521:Stroke / Q000175:diagnosis / Q000209:etiology; D013908:Thoracotomy; D013997:Time Factors; D016896:Treatment Outcome