Document Detail

Embolic cerebral insults after transapical aortic valve implantation detected by magnetic resonance imaging.
MedLine Citation:
PMID:  21087747     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: This study assessed the rate of periprocedural embolic ischemic brain injury during transapical aortic valve replacement in 25 consecutive patients.
BACKGROUND: Transcatheter aortic valve implantation is rapidly being established as a new therapeutic approach for aortic valve stenosis. Although initial clinical results are promising, it is unknown whether mobilization and embolization of calcified particles may lead to cerebral ischemia.
METHODS: Twenty-five consecutive patients (10 men, 15 women, mean age: 81 ± 5 years, mean log EuroSCORE [European System for Cardiac Operative Risk Evaluation]: 32 ± 10%) scheduled for transapical aortic valve implantation were included. All patients received a baseline cerebral magnetic resonance imaging scan. The scan was repeated approximately 6 days after valve implantation. The magnetic resonance imaging studies included axial diffusion-weighted, T(2)-weighted, fluid attenuated inversion recovery-weighted, and T(2) gradient echo sequences. Standardized assessment of the neurologic status was performed before aortic valve replacement and post-operatively.
RESULTS: Transapical aortic valve implantation was successfully performed in all patients. In 17 patients (68%), new cerebral lesions could be detected, whereas 8 patients showed no new cerebral insults. The pattern of distribution and morphology were typical of embolic origin. Despite the high incidence of morphologically detectable lesions, only 5 patients showed clinical neurologic alterations. Out of these patients, only 1 suffered from a permanent stroke.
CONCLUSIONS: New embolic ischemic cerebral insults are detected in 68% of patients after transapical valve implantation. Clinical symptoms are rare and usually transitory. Larger trials will need to establish the clinical significance of asymptomatic ischemic lesions as well as the rate of ischemic events in patients undergoing transfemoral valve replacement.
Martin Arnold; Susanne Schulz-Heise; Stephan Achenbach; Sabine Ott; Arnd Dörfler; Dieter Ropers; Richard Feyrer; Friedrich Einhaus; Sabrina Loders; Faidi Mahmoud; Olaf Roerick; Werner G Daniel; Michael Weyand; Stephan M Ensminger; Josef Ludwig
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  3     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-22     Completed Date:  2011-03-04     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1126-32     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Aged, 80 and over
Aortic Valve Stenosis / therapy*
Brain Ischemia / diagnosis*,  etiology
Cardiac Catheterization / adverse effects*
Diffusion Magnetic Resonance Imaging*
Heart Valve Prosthesis Implantation / adverse effects*,  methods
Intracranial Embolism / diagnosis*,  etiology
Neurologic Examination
Predictive Value of Tests
Stroke / diagnosis,  etiology
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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