title: Neurological Injury in Intermediate-Risk Transcatheter Aortic Valve Implantation.
abstract: The application of transcatheter aortic valve implantation (TAVI) to intermediate-risk patients is a controversial issue. Of concern, neurological injury in this group remains poorly defined. Among high-risk and inoperable patients, subclinical injury is reported on average in 75% undergoing the procedure. Although this attendant risk may be acceptable in higher-risk patients, it may not be so in those of lower risk.
  
  
  
  Forty patients undergoing TAVI with the Edwards SAPIEN-XT™prosthesis were prospectively studied. Patients were of intermediate surgical risk, with a mean±standard deviation Society of Thoracic Surgeons score of 5.1±2.5% and a EuroSCORE II of 4.8±2.4%; participant age was 82±7 years. Clinically apparent injury was assessed by serial National Institutes of Health Stroke Scale assessments, Montreal Cognitive Assessments (MoCA), and with the Confusion Assessment Method. These identified 1 (2.5%) minor stroke, 1 (2.5%) episode of postoperative delirium, and 2 patients (5%) with significant postoperative cognitive dysfunction. Subclinical neurological injury was assessed using brain magnetic resonance imaging, including diffusion-weighted imaging (DWI) sequences preprocedure and at 3±1 days postprocedure. This identified 68 new DWI lesions present in 60% of participants, with a median±interquartile range of 1±3 lesions/patient and volumes of infarction of 24±19 μL/lesion and 89±218 μL/patient. DWI lesions were associated with a statistically significant reduction in early cognition (mean ΔMoCA -3.5±1.7) without effect on cognition, quality of life, or functional capacity at 6 months.
  
  
  
  Objectively measured subclinical neurological injuries remain a concern in intermediate-risk patients undergoing TAVI and are likely to manifest with early neurocognitive changes.
  
  
  
  URL: http://www.anzctr.org.au. Australian & New Zealand Clinical Trials Registry: ACTRN12613000083796.
authors.affiliation: Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia jonathon_fanning@me.com.|The Heart & Lung Institute, Metro North Hospital and Health Service District, Brisbane, Queensland, Australia.|The University of Queensland, Herston, Queensland, Australia.
authors.forename: Jonathon P
authors.initials: JP
authors.lastname: Fanning
authors.affiliation: Department of Medical Imaging, The Prince Charles Hospital, Brisbane, Queensland, Australia.|The University of Queensland, Herston, Queensland, Australia.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Wesley
authors.affiliation: Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.|Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia.|The Heart & Lung Institute, Metro North Hospital and Health Service District, Brisbane, Queensland, Australia.|The University of Queensland, Herston, Queensland, Australia.
authors.forename: Darren L
authors.initials: DL
authors.lastname: Walters
authors.affiliation: Department of Geriatrics, The Prince Charles Hospital, Brisbane, Queensland, Australia.|The University of Queensland, Herston, Queensland, Australia.
authors.forename: Eamonn M
authors.initials: EM
authors.lastname: Eeles
authors.affiliation: Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.|School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Adrian G
authors.initials: AG
authors.lastname: Barnett
authors.affiliation: Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.|Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia.|The Heart & Lung Institute, Metro North Hospital and Health Service District, Brisbane, Queensland, Australia.|The University of Queensland, Herston, Queensland, Australia.
authors.forename: David G
authors.initials: DG
authors.lastname: Platts
authors.affiliation: Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.|Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia.|The Heart & Lung Institute, Metro North Hospital and Health Service District, Brisbane, Queensland, Australia.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Clarke
authors.affiliation: The University of Queensland, Herston, Queensland, Australia.|Department of Neurology, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Wong
authors.affiliation: Department of Medical Imaging, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Wendy E
authors.initials: WE
authors.lastname: Strugnell
authors.affiliation: Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Cliona
authors.initials: C
authors.lastname: O'Sullivan
authors.affiliation: Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.|Department of Physiotherapy, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Oystein
authors.initials: O
authors.lastname: Tronstad
authors.affiliation: Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.|Adult Intensive Care Unit, The Prince Charles Hospital, Brisbane, Queensland, Australia.|The Heart & Lung Institute, Metro North Hospital and Health Service District, Brisbane, Queensland, Australia.|The University of Queensland, Herston, Queensland, Australia.
authors.forename: John F
authors.initials: JF
authors.lastname: Fraser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001921:Brain / Q000000981:diagnostic imaging; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003693:Delirium / Q000000981:diagnostic imaging / Q000453:epidemiology*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology*; D065467:Transcatheter Aortic Valve Replacement
keywords: aortic stenosis; cerebrovascular disease/stroke; cognitive impairment; transcatheter aortic valve implantation