Prospective Evaluation of Neurocognition in Patients Following Transcatheter Aortic Valve Replacement

Background Data regarding change in neurocognitive function after transcatheter aortic valve replacement (TAVR) are conflicting. We sought to investigate the change in cognition up to 6 months post-TAVR in patients with mild cognitive impairment (MCI). Methods This is a prospective, observational, nonrandomized, cohort study of patients with MCI who underwent TAVR between February 2022 and June 2023 in a multicenter health care system. The inclusion criteria were TAVR patients with MCI, defined as a score of ≤25/30 on the Mini Montreal Cognitive Assessment (Mini MoCA) exam. The Mini MoCA exam was evaluated pre-TAVR, 30 days post-TAVR, and 6 months post-TAVR. Results Of 81 enrolled TAVR patients, 73 (90.1%) and 66 (81.5%) completed 30-day and 6-month post-TAVR MoCA exams, respectively. The median age was 81 (IQR: 75.0-86.0) years and 47.4% were male. At baseline, history of stroke, transient ischemic attack, and dementia were 17.3, 9.9%, and 9.9%, respectively. The Mini MoCA scores showed a small but significant increase from the preoperative assessment to the 30-day interval (21.0 [17.5-22.5] vs. 22.0 [18.5-24.5]; p < ​0.001) and was improved in 64.4% of patients. At 6 months, the Mini MoCA scores were increased in 89.4% of patients and had an absolute and significant increase of 2.3 points compared to preoperative assessment (23.3 [20.5-25.0] vs. 21.0 [17.6-22.9], p < ​0.001). Conclusions Among patients with baseline MCI undergoing TAVR, neurocognitive function as measured by the Mini MoCA exam significantly improved at 30 days and 6 months postprocedure. TAVR in the setting of MCI is a safe therapeutic option for patients with aortic valve disease.