title: Cognitive function after transapical aortic valve implantation: a single-centre study with 3-month follow-up.
abstract: OBJECTIVE
  Reports on adverse neurological events following transcatheter aortic valve implantation (TAVI) have focused on strokes, while more subtle postoperative cognitive decline has not yet been systematically investigated. In this study, we prospectively examined neurological and cognitive outcomes in patients undergoing transapical (TA) and surgical aortic valve replacement (AVR).
  
  
  METHODS
  A total of 64 patients with severe symptomatic aortic stenosis were investigated between January 2008 and July 2009. Clinical neurological examination and comprehensive neuropsychological testing were performed before and after the procedure, at discharge and at 3-month follow-up. Diffusion-weighted magnetic resonance imaging (DW-MRI) was applied to detect morphological brain injury.
  
  
  RESULTS
  TA-TAVI patients (n = 27) were older and at higher surgical risk compared with surgical AVR patients (n = 37; mean age 82.2 ± 4.7 vs 67.5 ± 8.9 years; log EuroSCORE 36.4 ± 13.2 vs 2.6 ± 8.5%, both P <0.001). There was one stroke in each group (3.7 vs 2.7%, P = 0.49), both classified as embolic based on imaging characteristics. After TA-TAVI, cognitive tests showed no decline during follow-up, while, after AVR, 7 of 11 tests showed a decline early after surgery. Similarly, with-in patient analysis showed that the rate of individuals with clinically relevant cognitive decline was increased early after AVR (TA-TAVI vs AVR: 18 vs 46% at discharge [P = 0.03]; 28 vs 6% at 3 months [P = 0.04]). New focal ischaemic cerebral lesions were detected on DW-MRI in 58% (7 of 12) of patients after TA-TAVI vs 34% (12 of 35) after AVR (P = 0.13). The number of brain lesions per patient and cumulative embolic load per patient were similar between groups. An association between postoperative cerebral ischaemia and cognitive dysfunction was not found (odds ratio 2.37, 95% confidence interval 0.05-113.75, P = 0.66).
  
  
  CONCLUSIONS
  Cognitive function was only mildly impaired after TA-TAVI when compared with a marked, albeit transient, decline after surgical AVR. Focal embolic brain injury tended to occur more frequently after TA-TAVI, but this was not related to cognitive decline during the 3-month follow-up.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, Essen, Germany. stephan.knipp@uk-essen.de
authors.forename: Stephan C
authors.initials: SC
authors.lastname: Knipp
authors.forename: Philipp
authors.initials: P
authors.lastname: Kahlert
authors.forename: Daniel
authors.initials: D
authors.lastname: Jokisch
authors.forename: Marc
authors.initials: M
authors.lastname: Schlamann
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendt
authors.forename: Christian
authors.initials: C
authors.lastname: Weimar
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
authors.forename: Matthias
authors.initials: M
authors.lastname: Thielmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000628:therapy*; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology; D006328:Cardiac Catheterization / Q000009:adverse effects*; D016009:Chi-Square Distribution; D003071:Cognition; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; 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; D009483:Neuropsychological Tests; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome