Key result
TAVI with the Lotus valve was associated with a higher incidence of new cerebral microinfarction compared to CoreValve (79% vs 59%, p=0.025), though neurocognitive function was preserved at 1 year.
Why the study?
To compare the incidence of silent cerebral infarction and its impact on cognitive function following TAVI with the first-generation CoreValve versus the second-generation Lotus valve.
Does TAVI with the Lotus valve compared to the CoreValve affect the incidence of silent cerebral infarction and cognitive function in patients with high-risk severe symptomatic aortic stenosis?
Observational (n=66)
Yes
Does TAVI with the Lotus valve compared to the CoreValve affect the incidence of silent cerebral infarction and cognitive function in patients with high-risk severe symptomatic aortic stenosis?
Although the Lotus valve was associated with a higher incidence of silent cerebral microinfarction compared to the CoreValve, neither prosthesis resulted in an objective decline in neurocognitive function at 1 year.
Answers are grounded in this paper and cite their sources.
Higher microinfarction rates with Lotus should not alter valve selection; leaves open long-term cognitive impact of TAVI prostheses.
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.
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Musa et al. (2019) conducted an observational in high-risk severe symptomatic aortic stenosis (n=66). Lotus valve vs. CoreValve was evaluated on Incidence of new cerebral microinfarction and objective decline in neurocognitive performance (p=0.025). TAVI with the Lotus valve was associated with a higher incidence of new cerebral microinfarction compared to CoreValve (79% vs 59%, p=0.025), though neurocognitive function was preserved at 1 year.
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