Impact of aortic valve type on cerebral ischemic lesions in DW-MRI after TAVR

  • K. B
  • T. H
  • J. W
 et al. 
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Abstract

BACKGROUND Subclinical cerebral ischemic lesions are detected by diffusion- weighted magnetic resonance imaging (DW-MRI) in the majority of patients after TAVR which may be associated with impaired short term neurological outcome. The impact of the TAVR device on cerebral ischemic lesions is not well defined. We aimed to analyze the incidence of cerebral ischemic lesions in a large cohort of patients undergoing TAVR with different devices. METHODS Consecutive high surgical risk patients with severe aortic valve stenosis treated with TAVR underwent DW-MRI 2-4 days after the procedure. DW-MRI scans were analyzed for the occurrence, number and volume of new ischemic lesions by a blinded physician. RESULTS One-hundred- fifty-two patients were enrolled, the majority received an Edwards SAPIEN 3 (ES 3) (57%), 15.2% an Edwards SAPIEN XT (ES XT), 23.2% a Direct Flow Medical (DFM), 3.3% a Lotus and 1.3% an Evolut R aortic valve. Cerebral ischemic lesions were detected in 70.4%. None of the patients was neurologically symptomatic. Cerebral lesions after TAVR were found for ES XT in 56.5%, ES 3 in 70.9%, DFM in 85.7%, Lotus in 20% and Evolute R 100% of patients, respectively, which was statistically significant in univariate analysis. Logistic regression analysis revealed valve type as the only independent predictor for new cerebral ischemic lesions (p=0.017). CONCLUSIONS Asymptomatic cerebral ischemic lesions after TAVR are observed frequently. The TAVR device type has a significant impact on the incidence of new cerebral ischemic lesions.

Author-supplied keywords

  • *aorta valve
  • *artificial embolism
  • *nuclear magnetic resonance imaging
  • *therapy
  • *transcatheter aortic valve implantation
  • Lotus
  • aorta valve stenosis
  • brain damage
  • devices
  • diffusion weighted imaging
  • human
  • logistic regression analysis
  • patient
  • physician
  • procedures
  • surgical risk
  • univariate analysis

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Authors

  • Bijuklic K.

  • Haselbach T.

  • Witt J.

  • Krause K.

  • Hansen L.

  • Gehrkens R.

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