title: Neurologic Complications of Unprotected Transcatheter Aortic Valve Implantation (from the Neuro-TAVI Trial).
abstract: Cerebral embolization during transcatheter aortic valve implantation (TAVI) can lead to a spectrum of clinically relevant manifestations, ranging from overt stroke to mild neurologic or cognitive deficits and subclinical cerebral infarcts. This study sought to determine the frequency of neurologic injury, cerebral ischemic lesions, and cognitive dysfunction in subjects undergoing contemporary commercial TAVI in the United States. Neuro-TAVR is the first prospective, multicenter study to use serial systematic neurologic and cognitive assessments and diffusion-weighted magnetic resonance imaging (at 4 ± 2 days after procedure) to investigate the incidence and severity of neurologic injury after contemporary unprotected TAVI in the United States. A total of 44 consecutive patients underwent TAVI at 5 US sites. Diffusion-weighted magnetic resonance imaging lesions were detected in 94%, with a mean of 10.4 ± 15.3 lesions per subject and a median total lesion volume of 295 mm3(interquartile range 71.6 to 799.6 mm3). New neurologic impairment (worsening in National Institutes of Health Stroke Scale score from baseline with new cerebral lesions) occurred in 22.6% (7 of 31) of subjects at discharge and 14.8% (4 of 27) at 30 days. In addition, cognitive decrements from baseline were identified by the Montreal Cognitive Assessment in 33% (12 of 36) of subjects at discharge and 41% (13 of 32) at 30 days. In conclusion, this contemporary cohort of US patients confirms that TAVI results in cerebral infarction in most patients and that 1 in 5 patients have measurable neurologic impairment and 1 in 3 patients have decrease in cognitive measures by Montreal Cognitive Assessment score after TAVI, reinforcing the need for methods to mitigate the risk of brain injury during TAVI.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Department of Cardiology, Yale Cardiovascular Research Group, New Haven, Connecticut. Electronic address: alexandra.lansky@yale.edu.
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.affiliation: Department of Cardiology, The Heart Hospital, Baylor Plano, Plano, Texas.
authors.forename: David
authors.initials: D
authors.lastname: Brown
authors.affiliation: Department of Cardiology, Baptist Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida.
authors.forename: Constantino
authors.initials: C
authors.lastname: Pena
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Department of Cardiology, Yale Cardiovascular Research Group, New Haven, Connecticut.
authors.forename: Cody G
authors.initials: CG
authors.lastname: Pietras
authors.affiliation: Department of Cardiology, Yale Cardiovascular Research Group, New Haven, Connecticut.
authors.forename: Helen
authors.initials: H
authors.lastname: Parise
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Vivian G
authors.initials: VG
authors.lastname: Ng
authors.affiliation: Department of Cardiology, Yale Cardiovascular Research Group, New Haven, Connecticut.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Meller
authors.affiliation: Department of Radiology, Baptist Hospital of Miami, Miami, Florida.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Abrams
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Michael
authors.initials: M
authors.lastname: Cleman
authors.affiliation: Keystone Heart Ltd., Herzliya, Israel.
authors.forename: Pauliina
authors.initials: P
authors.lastname: Margolis
authors.affiliation: Department of Cardiology, St. Francis Hospital, Roslyn, New York.
authors.forename: George
authors.initials: G
authors.lastname: Petrossian
authors.affiliation: Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Brickman
authors.affiliation: Global Institute for Research, Richmond, Virginia.
authors.forename: Szilard
authors.initials: S
authors.lastname: Voros
authors.affiliation: Department of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Moses
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: John K
authors.initials: JK
authors.lastname: Forrest
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001921:Brain / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology