Direct transcatheter aortic valve implantation (TAVI) decreases silent cerebral infarction when compared to routine balloon valvuloplasty.

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

International Journal of Cardiovascular Imaging Pub Date : 2023-10-01 Epub Date: 2023-06-26 DOI:10.1007/s10554-023-02895-x

Uğur Arslan, Güney Erdoğan, Mustafa Yenerçağ, Gökhan Aksan, Melisa Uçar, Selim Görgün, Çetin Kürşat Akpinar, Onur Öztürk, Osman Can Yontar, Ahmet Karagöz

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引用次数: 1

Abstract

Purpose: Silent cerebral infarctions (SCI), as determined by neuron-specific enolase (NSE) elevations, may develop after the transcatheter aortic valve implantation (TAVI) procedure. Our aim in this study was to compare the SCI rates between patients who underwent routine pre-dilatation balloon aortic valvuloplasty (pre-BAV) and patients who underwent direct TAVI without pre-BAV.

Methods: A total of 139 consecutive patients who underwent TAVI in a single center using the self-expandable Evolut-R valve (Medtronic, Minneapolis, Minnesota, USA) were included in the study. The first 70 patients were included in the pre-BAV group, and the last 69 patients were included in the direct TAVI group. SCI was detected by serum NSE measurements performed at baseline and 12 h after the TAVI. New NSE elevations > 12 ng/mL after the procedure were counted as SCI. In addition, SCI was scanned by MRI (magnetic resonance imaging) in eligible patients.

Results: TAVI procedure was successful in all of the study population. Post-dilatation rates were higher in the direct TAVI group. Post-TAVI NSE positivity (SCI) was higher in the routine pre-BAV group (55(78.6%) vs. 43(62.3%) patients, p = 0.036) and NSE levels were also higher in this group (26.8 ± 15.0 vs. 20.5 ± 14.8 ng/ml, p = 0.015). SCI with MRI was found to be significantly higher in the pre-BAV group than direct TAVI group (39(55.1%) vs. 31(44.9%) patients). The presence of atrial fibrillation and diabetes mellitus (DM), total cusp calcification volume, calcification at arcus aorta, routine pre-BAV and failure at first try of the prosthetic valve implantation were significantly higher in SCI (+) group. In the multivariate analysis, presence of DM, total cusp calcification volume, calcification at arcus aorta, routine pre-BAV and failure at first try of the prosthetic valve implantation were significantly associated with new SCI development.

Conclusions: Direct TAVI procedure without pre-dilation seems to be an effective method and avoidance of pre-dilation decreases the risk of SCI development in patients undergoing TAVI with a self-expandable valve.

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与常规球囊瓣膜成形术相比，直接经导管主动脉瓣植入术（TAVI）可减少无症状性脑梗死。

目的：通过神经元特异性烯醇化酶（NSE）升高确定的无症状性脑梗死（SCI）可能在经导管主动脉瓣植入术（TAVI）后发展。我们在本研究中的目的是比较接受常规扩张前球囊主动脉瓣成形术（前BAV）的患者和未接受前BAV的直接TAVI的患者的SCI发生率。前70名患者纳入BAV前组，后69名患者纳入直接TAVI组。通过在基线和TAVI后12小时进行的血清NSE测量来检测SCI。新的NSE高程 > 术后12ng/mL计算为SCI。此外，通过MRI（磁共振成像）对符合条件的患者进行SCI扫描。结果：TAVI手术在所有研究人群中均获得成功。直接TAVI组扩张后的发生率较高。常规BAV前组的TAVI后NSE阳性率（SCI）较高（55例（78.6%），而43例（62.3%），p = 0.036），NSE水平也较高（26.8 ± 15.0对20.5 ± 14.8 ng/ml，p = 发现BAV前组的SCI和MRI显著高于直接TAVI组（39例（55.1%）对31例（44.9%）患者）。SCI（+）组的心房颤动和糖尿病（DM）、总瓣尖钙化体积、主动脉弓钙化、常规预BAV和首次尝试人工瓣膜植入失败的发生率显著高于SCI（+。在多变量分析中，DM的存在、总瓣尖钙化体积、主动脉弓钙化、常规BAV前和首次尝试人工瓣膜植入失败与新的SCI发展显著相关。结论：不进行预扩张的直接TAVI手术似乎是一种有效的方法，避免预扩张可以降低使用自膨胀瓣膜进行TAVI的患者发生SCI的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Cardiovascular Imaging 医学-核医学

CiteScore

4.00

自引率

9.50%

发文量

审稿时长

1 months

期刊介绍： The International Journal of Cardiovascular Imaging publishes technical and clinical communications (original articles, review articles and editorial comments) associated with cardiovascular diseases. The technical communications include the research, development and evaluation of novel imaging methods in the various imaging domains. These domains include magnetic resonance imaging, computed tomography, X-ray imaging, intravascular imaging, and applications in nuclear cardiology and echocardiography, and any combination of these techniques. Of particular interest are topics in medical image processing and image-guided interventions. Clinical applications of such imaging techniques include improved diagnostic approaches, treatment , prognosis and follow-up of cardiovascular patients. Topics include: multi-center or larger individual studies dealing with risk stratification and imaging utilization, applications for better characterization of cardiovascular diseases, and assessment of the efficacy of new drugs and interventional devices.