Following CoreValve TAVI, new cerebral infarcts occurred in 77% of patients, with increased age and aortic arch atheroma severity as independent risk factors, though overall HRQoL improved.
Observational (n=31)
What is the incidence of cerebral infarction following TAVI, what are its predictive risk factors, and does it impact health-related quality of life in patients with aortic stenosis?
Silent cerebral infarcts are highly common (77%) following TAVI and are predicted by age and aortic atheroma severity, but do not appear to negatively impact short-term health-related quality of life.
BACKGROUND: 'Silent' cerebral infarction and stroke are complications of transcatheter aortic valve implantation (TAVI). OBJECTIVE: To assess the occurrence of cerebral infarction, identify predictive risk factors and examine the impact on patient health-related quality of life (HRQoL). METHODS: Cerebral diffusion weighted MRI of 31 patients with aortic stenosis undergoing CoreValve TAVI was carried out. HRQoL was assessed at baseline and at 30 days by SF-12v2 and EQ5D questionnaires. RESULTS: New cerebral infarcts occurred in 24/31 patients (77%) and stroke in 2 (6%). Stroke was associated with a greater number and volume of cerebral infarcts. Age (r=0.37, p=0.042), severity of atheroma (arch and descending aorta; r=0.91, p<0.001, r=0.69, p=0.001, respectively) and catheterisation time (r=0.45, p=0.02) were predictors of the number of new cerebral infarcts. HRQoL improved overall: SF-12v2 physical component summary increased significantly (32.4±6.2 vs 36.5±7.2; p=0.03) with no significant change in mental component summary (43.5±11.7 vs. 43.1±14.3; p=0.85). The EQ5D score and Visual Analogue Scale showed no significant change (0.56±0.26 vs. 0.59±0.31; p=0.70, and 54.2±19 vs. 58.2±24; p=0.43). CONCLUSION: Multiple small cerebral infarcts occurred in 77% of patients with TAVI. The majority of infarcts were 'silent' with clinical stroke being associated with a both higher infarct number and volume. Increased age and the severity of aortic arch atheroma were independent risk factors for the development of new cerebral infarcts. Overall HRQoL improved and there was no association between the number of new cerebral infarcts and altered health status.
Fairbairn et al. (2011) conducted an observational in Aortic stenosis (n=31). CoreValve TAVI was evaluated on Occurrence of new cerebral infarcts on diffusion-weighted MRI. Following CoreValve TAVI, new cerebral infarcts occurred in 77% of patients, with increased age and aortic arch atheroma severity as independent risk factors, though overall HRQoL improved.