Key result
Post-TAVR cerebral blood flow increases ~44% but is not linked to postinterventional delirium.
Why the study?
The impact of transcatheter aortic valve replacement on global and cerebral hemodynamics and their relationship to postinterventional delirium remains largely unexplored.
Does transcatheter aortic valve replacement alter cerebral blood flow, and are these changes associated with postinterventional delirium in patients undergoing TAVR?
Cohort (n=52)
No
Does transcatheter aortic valve replacement alter cerebral blood flow, and are these changes associated with postinterventional delirium in patients undergoing TAVR?
While TAVR increases cardiac output and consequently cerebral blood flow, these global cerebral blood flow changes do not appear to drive post-TAVR delirium, though regional cerebral oxygenation mismatches might play a role.
CBF rise post-TAVR tracks cardiac output without linking to delirium; leaves open whether NIRS oxygenation changes predict risk.
Background: Despite the success of transcatheter aortic valve repair (TAVR) over the past years, its impact on global and cerebral hemodynamics remains largely unexplored. Changes in cerebral blood flow may be associated with delirium, which may occur in 26 to 29% of cases. We aimed to examine the relationships between global hemodynamic parameters and cerebral parameters in patients who underwent TAVR and their impact on postinterventional delirium. Methods: Patients scheduled for TAVR were enrolled after obtaining written informed consent. Patients received light sedation according to standard procedures. Cerebral blood flow (CBF) was measured with a noninvasive near-infrared spectroscopy-based method using intravenous indocyanine green injection. CBF measurements were taken at the beginning of the TAVR procedure and after the valve was in place. Patients were screened for delirium using CAM-ICU and NuDESC tests before and after intervention. Results: A total of 52 of 60 patients remained for analysis. Thirteen patients (25%) developed delirium. Mean arterial pressure (MAP) remained unchanged, while cardiac output increased after TAVR by 44%. CBF also increased after TAVR. No significant difference was observed in CBF changes between the groups with and without delirium. A linear mixed model analysis revealed a linear relationship between CO and CBF but not between MAP and CBF. In an exploratory analysis, decreased cerebral oxygenation and increased deoxygenated hemoglobin, as measured by NIRS after TAVR, were associated with delirium. Conclusions: The results confirm that CO is an independent factor in CBF, while CBF changes per se are not linked to delirium. However, we found a mismatch between CBF and regional cerebral parameters, which may reflect cerebral metabolism and its relation to the development of delirium. This remains to be confirmed by further studies.
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Oremek et al. (2025) conducted a cohort in Aortic stenosis requiring transcatheter aortic valve replacement (TAVR) (n=52). Transcatheter aortic valve replacement (TAVR) vs. Pre-intervention baseline was evaluated on Difference in cerebral blood flow (CBF) changes between patients with and without postinterventional delirium. Although cerebral blood flow increased by 44% following transcatheter aortic valve replacement, this increase was not significantly associated with the development of postinterventional delirium.
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