Author + information
TAVR is associated with a spectrum of brain injuries. Studies have correlated the likelihood of neurological events with increasing magnitude of microemboli. Recently, a Cerebral Protection System became FDA approved to reduce the risk of stroke during TAVR. Our study evaluated the generation of microemboli during the stages of TAVR.
Single center, TAVR database queried 1/2013-12/2014, to identify patients who had neuromonitoring during TAVR. 62 patients had complete bilateral data. Neuromonitoring measured cerebral microembolic HITS and bilateral oxygen saturation. Data points were recorded cumulatively: pre-incision, pre-valvuloplasty, valvuloplasty, valve replacement (defined as the valve crossing the annulus), end of 1st pacing run, post-deployment, and closing. The increase between two successive time points was calculated by percent increase.
Figure 1 shows the pattern of HITS. 24 (38%) patients had pre-valvuloplasty HITS measured at 0. Pre-valvuloplasty to valvuloplasty median increase in HITS was 81% left, 112% right side. Valvuloplasty to crossing the annulus, median increase 63% bilaterally. From crossing to the end of 1st pacing, HITS increase 106% left and 97% right. From 1st pacing run to post-deployment, bilateral increase 33%. Post-deployment to closing increase was 11% left, 6% right.
The maximum increase in the microemboli during TAVR occurred between the valve crossing the annulus and the end of the 1st pacing run. Studies using the embolic protection devices are warranted to identify the efficacy in reducing microemboli at the time of valve deployment.
STRUCTURAL: Valvular Disease: Aortic