title: Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients.
abstract: OBJECTIVE
  The risk of neurological damage following transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) in severe aortic stenosis patients deemed to be at intermediate surgical risk is unknown. In this target population, the degree of neurological damage was compared using brain diffusion-weighted magnetic resonance imaging (DW-MRI) and cognitive testing.
  
  
  METHODS
  Forty-six consecutive patients undergoing TAVI (78.0 ± 8.3 years; STS score 4.4 ± 1.7) and 37 patients undergoing SAVR (78.9 ± 6.2 years, STS score 4.7 ± 1.7) were compared. DW-MRI was performed in 67 patients (40 in TAVI vs. 27 in SAVR group) within the first 15 days post-procedure. A cognitive assessment was performed at baseline and at 3 months follow-up. The occurrence of potential cognitive impairment post-intervention was determined using the reliable change index (RCI).
  
  
  RESULTS
  Baseline characteristics were comparable in TAVI and SAVR groups except for the presence of severe calcified aorta, which occurred more frequently in the TAVI group [17 (37 %) vs. 0 (0 %), p < 0.001]. Three patients presented a clinical stroke: 1 (2.2 %) in TAVI group vs. 2 (5.4 %) in SAVR group, (p = 0.58). No differences were observed in the rate of acute ischemic cerebral lesions detected by DWI in patients undergoing TAVI vs. SAVR [18 (45 %) in TAVI vs. 11 (40.7 %) in SAVR, adjusted OR 0.95; 95 % CI 0.25-3.65; p = 0.94]. TAVI was associated with a lower number of DWI lesions (adjusted OR 0.54; 95 % IC 0.37-0.79; p = 0.02). An older age was a predictor of the occurrence of acute lesions (OR 1.13; 95 % CI 1.03-1.23; p = 0.01), and the use of vitamin-K antagonist therapy had a protective effect (OR 0.25; 95 % CI 0.07-0.92; p = 0.037) regardless the type of intervention. Overall no significant changes were observed in global cognitive scores post-intervention (p = 0.23). The RCI showed mild cognitive decline in nine patients undergoing TAVI (26.4 %) and in six patients in the SAVR group (30.0 %) (p = 0.96). There was no association between the number and total volume of lesions and the occurrence of cognitive decline (CC Spearman 0.031, p = 0.85 and -0.011, p = 0.97, respectively).
  
  
  CONCLUSIONS
  TAVI and SAVR were associated with a similar rate of acute silent ischemic cerebral lesions in intermediate risk patients. Although acute lesions occurred very frequently in both strategies, their cognitive impact was not clinically relevant.
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Omar
authors.initials: O
authors.lastname: Abdul-Jawad Altisent
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. nachoferreira@secardiologia.es.|CIBER of Epidemiology and Public Health (CIBERSP), Murcia, Spain. nachoferreira@secardiologia.es.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ferreira-Gonzalez
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.|CIBER of Epidemiology and Public Health (CIBERSP), Murcia, Spain.
authors.forename: Josep R
authors.initials: JR
authors.lastname: Marsal
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.|CIBER of Epidemiology and Public Health (CIBERSP), Murcia, Spain.
authors.forename: Aida
authors.initials: A
authors.lastname: Ribera
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Auger
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Ortega
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Purificación
authors.initials: P
authors.lastname: Cascant
authors.affiliation: Quebec Heart and Lung Institut, Laval University, Quebec City, QC, Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Bruno Garcia
authors.initials: BG
authors.lastname: Del Blanco
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Vicenç
authors.initials: V
authors.lastname: Serra
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Sureda
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Igual
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Alex
authors.initials: A
authors.lastname: Rovira
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: María Teresa
authors.initials: MT
authors.lastname: González-Alujas
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Gonzalez
authors.affiliation: Quebec Heart and Lung Institut, Laval University, Quebec City, QC, Canada.|Department of Medicine, University of Adelaide, Adelaide, SA, Australia.|Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland, OH, USA.
authors.forename: Rishi
authors.initials: R
authors.lastname: Puri
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Hug
authors.initials: H
authors.lastname: Cuellar
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Tornos
authors.affiliation: Quebec Heart and Lung Institut, Laval University, Quebec City, QC, Canada.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Garcia-Dorado
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D016009:Chi-Square Distribution; D003071:Cognition; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardiac valvular surgery; Catheterization; Magnetic resonance imaging; Stroke; Valves