Key result
Direct transcatheter aortic valve implantation without pre-dilation significantly reduced the incidence of silent cerebral infarction compared to routine balloon valvuloplasty (62.3% vs 78.6%, p=0.036).
Why the study?
Silent cerebral infarctions may develop after TAVI, prompting a comparison of rates between routine pre-dilatation balloon aortic valvuloplasty and direct TAVI without pre-BAV.
Does direct TAVI without pre-dilatation reduce silent cerebral infarction in patients with aortic stenosis undergoing TAVI?
Cohort (n=139)
Open-label
None (Sequential allocation)
No
Does direct TAVI without pre-dilatation reduce silent cerebral infarction in patients with aortic stenosis undergoing TAVI?
Answers are grounded in this paper and cite their sources.
Purpose: Silent cerebral infarctions (SCI), as determined by neuron-specific enolase (NSE) elevations, may develop after the transcatheter aortic valve implantation (TAVI) procedure. Our aim in this study was to compare the SCI rates between patients who underwent routine pre-dilatation balloon aortic valvuloplasty (pre-BAV) and patients who underwent direct TAVI without pre-BAV. Methods: A total of 139 consecutive patients who underwent TAVI in a single center using the self-expandable Evolut-R valve (Medtronic, Minneapolis, Minnesota, USA) were included in the study. The first 70 patients were included in the pre-BAV group, and the last 69 patients were included in the direct TAVI group. SCI was detected by serum NSE measurements performed at baseline and 12 h after the TAVI. New NSE elevations > 12 ng/mL after the procedure were counted as SCI. In addition, SCI was scanned by MRI (magnetic resonance imaging) in eligible patients. Results: TAVI procedure was successful in all of the study population. Post-dilatation rates were higher in the direct TAVI group. Post-TAVI NSE positivity (SCI) was higher in the routine pre-BAV group (55(78.6%) vs. 43(62.3%) patients, p=0.036) and NSE levels were also higher in this group (26.8 ± 15.0 vs. 20.5 ± 14.8 ng/ml, p=0.015). SCI with MRI was found to be significantly higher in the pre-BAV group than direct TAVI group (39(55.1%) vs. 31(44.9%) patients). The presence of atrial fibrillation and diabetes mellitus (DM), total cusp calcification volume, calcification at arcus aorta, routine pre-BAV and failure at first try of the prosthetic valve implantation were significantly higher in SCI (+) group. In the multivariate analysis, presence of DM, total cusp calcification volume, calcification at arcus aorta, routine pre-BAV and failure at first try of the prosthetic valve implantation were significantly associated with new SCI development. Conclusions: Direct TAVI procedure without pre-dilation seems to be an effective method and avoidance of pre-dilation decreases the risk of SCI development in patients undergoing TAVI with a self-expandable valve.
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Arslan et al. (2022) conducted a cohort in Aortic Stenosis (n=139). Direct transcatheter aortic valve implantation (TAVI) without pre-dilatation vs. Routine pre-dilatation balloon aortic valvuloplasty (pre-BAV) was evaluated on Silent cerebral infarction (SCI) detected by new neuron-specific enolase (NSE) elevations > 12 ng/mL (p=0.036). Direct transcatheter aortic valve implantation without pre-dilation significantly reduced the incidence of silent cerebral infarction compared to routine balloon valvuloplasty (62.3% vs 78.6%, p=0.036).
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