RT Journal Article
SR Electronic
T1 Silent cerebral infarction and cognitive function following TAVI: an observational two-centre UK comparison of the first-generation CoreValve and second-generation Lotus valve
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e022329
DO 10.1136/bmjopen-2018-022329
VO 9
IS 1
A1 Tarique Al Musa
A1 Akhlaque Uddin
A1 Catherine Loveday
A1 Laura E Dobson
A1 Mark Igra
A1 Fiona Richards
A1 Peter P Swoboda
A1 Anvesha Singh
A1 Pankaj Garg
A1 James R J Foley
A1 Graham J Fent
A1 Anthony J P Goddard
A1 Christopher Malkin
A1 Sven Plein
A1 Daniel J Blackman
A1 Gerald P McCann
A1 John P Greenwood
YR 2019
UL http://bmjopen.bmj.com/content/9/1/e022329.abstract
AB 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.