Author + information
- Received April 16, 2010
- Revision received July 6, 2010
- Accepted July 27, 2010
- Published online January 4, 2011.
- Josep Rodés-Cabau, MD*,* (, )
- Eric Dumont, MD*,
- Robert H. Boone, MD†,
- Eric Larose, MD*,
- Rodrigo Bagur, MD*,
- Ronen Gurvitch, MBBS†,
- Fernand Bédard, MD‡,
- Daniel Doyle, MD*,
- Robert De Larochellière, MD*,
- Cleonie Jayasuria, MD†,
- Jacques Villeneuve, MD*,
- Alier Marrero, MD§,
- Mélanie Côté, MSc*,
- Philippe Pibarot, PhD* and
- John G. Webb, MD†
- ↵*Reprint requests and correspondence:
Dr. Josep Rodés-Cabau, Quebec Heart & Lung Institute, Laval University, 2725 chemin Ste-Foy, G1V 4G5 Quebec City, Quebec, Canada
Objectives The objective of this study was to compare the incidence of cerebral embolism (CE) as evaluated by diffusion-weighted magnetic resonance imaging (DW-MRI) following transapical (TA) transcatheter aortic valve implantation (TAVI) versus transfemoral (TF) TAVI.
Background The TA-TAVI approach avoids both the manipulation of large catheters in the aortic arch/ascending aorta and the retrograde crossing of the aortic valve, and this avoidance might lead to a lower rate of CE.
Methods This was a prospective multicenter study including 60 patients who underwent cerebral DW-MRI the day before and within the 6 days following TAVI (TF approach: 29 patients; TA approach: 31 patients). Neurologic and cognitive function assessments were performed at DW-MRI time points.
Results The TAVI procedure was performed with the Edwards valve and was successful in all cases but one (98%). A total of 41 patients (68%) had 251 new cerebral ischemic lesions at the DW-MRI performed 4 ± 1 days after the procedure, 19 patients in the TF group (66%) and 22 patients in the TA group (71%; p = 0.78). Most patients (76%) with new ischemic lesions had multiple lesions (median number of lesions per patient: 3, range 1 to 31). There were no differences in lesion number and size between the TF and TA groups. No baseline or procedural factors were found to be predictors of new ischemic lesions. The occurrence of CE was not associated with a measurable impairment in cognitive function, but 2 patients (3.3%) had a clinically apparent stroke within the 24 h following the procedure (1 patient in each group).
Conclusions TAVI is associated with a high rate of silent cerebral ischemic lesions as evaluated by DW-MRI, with no differences between the TF and TA approaches. These results provide important novel insight into the mechanisms of CE associated with TAVI and support the need for further research to both reduce the incidence of CE during these procedures and better determine their clinical relevance.
The study was supported by a grant of the Fondation de l'Institut Universitaire de Cardiologie et de Pneumologie de Quebec and by a grant (MOP 57745) of the Canadian Institutes of Health Research, Ottawa, Ontario, Canada. Dr. Pibarot holds the Canada Research Chair in Valvular Heart Disease, Canadian Institutes of Health Research, and has received an honorarium and research grant from Edwards Lifesciences. Drs. Rodés-Cabau, Dumont, Doyle, and Webb are consultants for Edwards Lifesciences Inc. Dr. Webb is a consultant for Embrella Inc. All other authors have reported that they have no relationships to disclose.
- Received April 16, 2010.
- Revision received July 6, 2010.
- Accepted July 27, 2010.
- American College of Cardiology Foundation