title: Increased Risk of Cerebral Embolization After Implantation of a Balloon-Expandable Aortic Valve Without Prior Balloon Valvuloplasty.
abstract: OBJECTIVE
  The purpose of this study was to analyze the effect of transcatheter aortic valve replacement (TAVR) without versus with prior balloon aortic valvuloplasty (BAV) on the risk of cerebral embolization in patients who receive a balloon-expandable valve.
  
  
  BACKGROUND
  Avoiding BAV prior to TAVR may simplify the procedure, but the risk of cerebral embolization is currently unknown.
  
  
  METHODS
  A total of 87 consecutive high surgical-risk patients with no contraindications for diffusion-weighted magnetic resonance imaging (DW-MRI) were enrolled. Thirty-two patients received a balloon-expandable aortic valve with and 55 patients without BAV. The incidence, number, and volume of new ischemic lesions in DW-MRI performed 2 to 7 days after TAVI were evaluated.
  
  
  RESULTS
  Mean age (83.8 ± 5.2 years vs. 82.9 ± 6.8 years) and sex (43.8% vs. 52.7% male) of the patients with versus without BAV, respectively, as well as other demographic and hemodynamic data were not significantly different between both groups. The procedural success rate was 93.5% with and 98.2% without BAV, and procedure duration and contrast volume were significantly lower without BAV. The incidence of new cerebral ischemic lesions in the total cohort was 66.7%. Compared with patients with BAV, those without BAV had a significantly higher total volume of cerebral ischemic lesions (235.4 ± 331.4 mm(3) vs. 89.5 ± 128.2 mm(3); p = 0.01).
  
  
  CONCLUSIONS
  The implantation of a balloon-expandable aortic valve without versus with prior BAV, although performed with a shorter procedure time and lower contrast volume, is associated with a significantly higher volume of cerebral ischemic lesions.
authors.affiliation: Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg, Germany.
authors.forename: Klaudija
authors.initials: K
authors.lastname: Bijuklic
authors.affiliation: Department of Cardiac Surgery, Albertinen Heart Center, Hamburg, Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Haselbach
authors.affiliation: Department of Cardiology, Albertinen Heart Center, Hamburg, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Witt
authors.affiliation: Department of Cardiology, Albertinen Heart Center, Hamburg, Germany.
authors.forename: Korff
authors.initials: K
authors.lastname: Krause
authors.affiliation: Department of Cardiac Surgery, Albertinen Heart Center, Hamburg, Germany.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Hansen
authors.affiliation: Department of Radiology, Albertinen Hospital, Hamburg, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Gehrckens
authors.affiliation: Department of Cardiac Surgery, Albertinen Heart Center, Hamburg, Germany.
authors.forename: Friedrich-Christian
authors.initials: FC
authors.lastname: Rieß
authors.affiliation: Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg, Germany; Department for Percutaneous Treatment of Structural Heart Disease, Albertinen Heart Center, Hamburg, Germany. Electronic address: schofer@herz-hh.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Schofer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000009:adverse effects*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D016022:Case-Control Studies; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006439:Hemodynamics; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: DW-MRI; TAVR; balloon valvuloplasty; cerebral ischemic lesions