Silent cerebral infarction and cognitive function following TAVI: an observational two-centre UK comparison of the first-generation CoreValve and second-generation Lotus valve

Al Musa, Tarique, Uddin, Akhlaque, Loveday, Catherine, Dobson, Laura E., Igra, Mark, Richards, Fiona, Swoboda, Peter P., Singh, Anvesha, Garg, Pankaj, Foley, James R. J., Fent, Graham J., Goddard, Anthony J. P., Malkin, Christopher, Plein, Sven, Blackman, Daniel J., McCann, Gerald P. and Greenwood, John P. (2019) Silent cerebral infarction and cognitive function following TAVI: an observational two-centre UK comparison of the first-generation CoreValve and second-generation Lotus valve. BMJ Open, 9 (1). ISSN 2044-6055

[img] PDF (Published_Version) - Published Version
Available under License Creative Commons Attribution Non-commercial.

Download (832kB)

Abstract

Objective: To compare the incidence of silent cerebral infarction and impact on cognitive function following transcatheter aortic valve implantation (TAVI) with the first-generation CoreValve (Medtronic, Minneapolis, Minnesota, USA) and second-generation Lotus valve (Boston Scientific, Natick Massachusetts, USA). Design: A prospective observational study comprising a 1.5 T cerebral MRI scan, performed preoperatively and immediately following TAVI, and neurocognitive assessments performed at baseline, 30 days and 1 year follow-up. Setting: University hospitals of Leeds and Leicester, UK. Patients 66 (80.6±8.0 years, 47% male) patients with high-risk severe symptomatic aortic stenosis recruited between April 2012 and May 2015. Main outcome measures: Incidence of new cerebral microinfarction and objective decline in neurocognitive performance. Results: All underwent cerebral MRI at baseline and immediately following TAVI, and 49 (25 Lotus, 24 CoreValve) completed neurocognitive assessments at baseline, 30 days and 1 year. There was a significantly greater incidence of new cerebral microinfarction observed following the Lotus TAVI (23 (79%) vs 22 (59%), p=0.025) with a greater number of new infarcts per patient (median 3.5 (IQR 7.0) vs 2.0 (IQR 3.0), p=0.002). The mean volume of infarcted cerebral tissue per patient was equivalent following the two prostheses (p=0.166). More patients suffered new anterior (14 (48%) vs 2 (5%), p=0.001) and vertebrobasilar (15 (52%) vs 7 (19%), p=0.005) lesions following Lotus. Lotus was associated with a decline in verbal memory and psychomotor speed at 30 days. However, performance longitudinally at 1 year was preserved in all neurocognitive domains. Conclusions: There was a higher incidence of silent cerebral microinfarction and a greater number of lesions per patient following Lotus compared with CoreValve. However, there was no objective decline in neurocognitive function discernible at 1 year following TAVI with either prosthesis.

Item Type: Article
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Related URLs:
Depositing User: LivePure Connector
Date Deposited: 19 Nov 2021 01:40
Last Modified: 26 Nov 2021 01:39
URI: https://ueaeprints.uea.ac.uk/id/eprint/82225
DOI: 10.1136/bmjopen-2018-022329

Actions (login required)

View Item View Item