Author + information
- Ermela Yzeiraj1,
- Timo Haselbach2,
- Julian Witt3,
- Klaudija Bijuklic1,
- Lorenz Hansen2,
- Friedrich-Christian Rieß4 and
- Joachim Schofer5
- 1Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg, Germany
- 2Albertinen Krankenhaus, Hamburg, Germany
- 3Albertinen Krankenhaus Hamburg, Hamburg, Germany
- 4Albertinen Heart Center, Hamburg, Germany, Hamburg, Germany
- 5Medical Care Center Prof. Mathey, Prof. Schofer and Albertinen Heart Center, Hamburg, Hamburg, Germany
Transcatheter aortic valve replacement (TAVR) is associated with the risk of symptomatic or silent cerebral infarcts (CIs). The role of aortic valve calcification on CIs is not well known. The purpose of this study was to investigate the impact of aortic valve complex calcification on CIs in patients with a wide range of calcification undergoing TAVR using a retrievable prosthesis and to identify predictors of CIs.
One hundred and nine consecutive patients who underwent transfemoral TAVR using the Direct Flow Medical (DFM, Santa Rosa, California) prosthesis and received a cerebral DW-MRI 3-5 day after TAVR, were included in the study. Volumetric quantification of aortic valve complex calcification was performed from pre-procedural multislice computed tomography.
Out of 109 patients, 102 (93.6) had severe calcified aortic valve stenosis (AVS) and 7 patients (6.4%) had pure aortic regurgitation (AR). Aortic valve complex calcium in patients with AVS was 290 mm3 and in patients with AR 12 mm3 (p=0.009). New CIs were found in 78% of patients. The incidence of CIs was comparable between patients with AVS and patients with pure AR (77.5% versus 85.7%, p=1.000) whereas the number of new CIs per patient was significantly higher in the pure AR group (median 4 (IQR 3-13) versus 2 (IQR 1-5), p=0.001). The same was true for total lesion volume per patient (280 mm3 (241-2319) in patients with pure AR versus 148 mm3 (18-368) in patients with AVS, p=0.013). In the multivariate logistic regression analysis no independent predictor for new CIs could be identified.
Patients with calcified AVS undergoing TAVI do not have a higher incidence of CIs compared to patients with pure AR. Surprisingly, patients with pure AR had higher lesion number and volume per patient. Aortic valve calcification was not correlated with CIs. Further studies are needed to better understand the mechanism of CIs and address the use of cerebral protection devices during TAVR procedure.
STRUCTURAL: Valvular Disease: Aortic