TAVR, Surgical AVR Patients Show Similar Rates of Neurological Damage

San Francisco, CA—Neurological damage and cognitive decline were similar between patients undergoing transcatheter and surgical aortic valve replacement, according to results from a nonrandomized, single-center study presented at TCT. Neurological issues following these procedures may be more closely linked to baseline characteristics than to the procedures themselves.     

Omar Abdul-Jawad Altisent, MD, of Mútua Terrassa Hospital, Terrassa, Spain, and colleagues compared TAVR and SAVR results among patients with similar baseline risk. Thirty-one patients undergoing TAVR and 27 undergoing SAVR were included. The investigators used diffusion-weighted (DW) MRI in 47 of the patients (25 TAVR patients and 22 SAVR patients) to detect silent cerebral ischemic lesions along with a neurocognitive assessment performed by a neuropsychologist in 41 of the patients (26 TAVR patients and 15 SAVR patients) at baseline and after 3 months. DW MRI was conducted a mean of 6.6 days following intervention.     

Patients in the two groups were similar with regard to age (76.8 years TAVR vs. 75.0 years SAVR; P=.6) and log EuroScore (12.6% TAVR vs. 14.6% SAVR; P=.3). Of the full cohort, 18 patients (38%) had new cerebral ischemic lesions on DW MRI. There were no significant differences between the groups with regard to the presence of new ischemic lesions on MRI, number of lesions or volume of lesions (see Table).      

Table. DW MRI Following TAVR and SAVR

Using the Reliable Change Index, cognitive decline was seen in 12.2% of all 41 patients assessed, including three TAVR patients (11.5%) and two SAVR patients (13.3%; P=.7); the decline was not considered to have any clinical relevance, and Dr. Altisent noted that there was also no association seen between the number and extent of cerebral lesions and cognitive decline.   

“Probably, the rate of new cerebral foci detected by MRI is more associated with the baseline characteristics of patients than with the intervention performed,” Dr. Altisent told TCT Daily. These characteristics could include aortic atheromatosis, age and frailty.

Dr. Altisent said that several earlier studies have examined the issue of neurological decline following cardiac intervention, but results are conflicting, possibly because of differing study protocols. These new results remain limited by a small number of included patients, as well as the limitations inherent to single-center, nonrandomized studies. “This is especially true in a study focused on an elderly population with high comorbidities,” Dr. Altisent said. Further research in this field will focus on the impact of aortic atheromatosis on new foci detected with MRI, as well as on the clinical significance of those foci and cognitive decline.