Clinical and neurophysiological results of transcatheter aortic valve implantation

• Tarasova I.V.
• Tarasov R.S.
• Syrova I.D.
• Sosnina A.S.
• Kupriyanova D.S.
• Kolesnikov A.Yu.
• Trubnikova O.A.
• Ganykov V.I.

Abstract

Aim – to evaluate the clinical and neurophysiological parameters of patients undergoing transcatheter aortic valve implantation (TAVI).

Material and methods. The present study included 30 patients (26 of them women), according to the inclusion criteria, median age was 75 years. Additionally, to the standard clinical examination, all patients underwent a neurophysiological examination using with the Montreal Cognitive Assessment (MoCA), extended neuropsychological testing, and digital electroencephalography (EEG) 1–2 days before the and at 5–7 days after TAVI.

Results. A balloon-expandable type of transcatheter valve (Sapien XT) was implanted in the aortic position in 10% of cases (n=3), while self-expanding valve (Acurate, EvolutR, Portico) were used in 90% of TAVI patients. Almost all patients (n=29) underwent surgery under local anaesthesia (1 case – general anaesthesia with mechanical ventilation). The duration of the hospital period and the intensive care stay in patients did not exceed 10 and 2 days, respectively. There were no adverse cardiovascular events during the in-hospital period of TAVI. In three cases (10%) during the hospitalization period of TAVI, implantation of a permanent pacemaker was required as a result of the development of significant atrioventricular conduction disorders. Extended neuropsychological testing revealed postoperative cognitive dysfunction (POCD) in 80% of cases (n=24). Deterioration of executive functions was observed in 26 (87%) patients. A combination of decreased executive functions and short-term memory – in 18 (60%). According to EEG data, patients showed signs of cortical dysfunction after TAVI with an increase in theta (4–8 Hz) and low-frequency alpha activity (8–10 Hz) compared with the preoperative level.

Conclusion. Despite the satisfactory clinical outcomes of the TAVI procedure, a high incidence of POCD was revealed with a predominant deterioration in executive functions and short-term memory, as well as manifestations of cortical dysfunction in the form of an increase in slow-wave EEG activity. The obtained data point to the need for further study of the brain functioning under the influence of factors accompanying TAVI and increasing its safety for the cognitive functioning of patients.

Keywords:transcatheter aortic valve implantation; neurophysiological status; postoperative cognitive dysfunction; electroencephalography

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