Original title: Cognitive trajectory after transcatheter aortic valve implantation. Reference: Ghanem A et al. Circulation Cardiovasc Intervent. 2013;Epub ahead of print
Several studies showed that silent cerebral embolism in patients undergoing percutaneous aortic valve replacement is frequent but seems that does not affect the long-term cognitive functions according to this new study.
This study included 111 patients who received a percutaneous valve and an assessment of their cognitive functions pre-procedure and subsequently at 3 days, 3 months, 1 year and 2 years.
All patients had normal results pre-procedure and except for one case of ischemic stroke at 8 months post implant no other neurological events were observed in the rest of the population. The overall population mortality at 2 years was 31.5 %. Cognitive decline was observed early (in the evaluation at 3 days) in 6 patients (5.4 %) of which in 3 patients, deterioration persisted at follow-up. The few who experienced cognitive decline were mainly affected by their construction and visual skills as well as language, attention and memory. 105 patients (94.6 %) which showed no early deterioration evolved stable in most of the tests performed on the track. Hemodialysis patients were more predisposed to early deterioration (50 % versus 5%, P = 0.009) as well as those who required longer procedures (123 min versus 85 min , P = .03 ). Bleeding complications were not associated with further deterioration. Of the total, 56 patients underwent MRI showing signs of stroke in 64%. When comparing patients with and without evidence of stroke on MRI, there were no differences in cognitive function at 2 years follow up. The only predictor of cognitive decline at follow up (as expected) was age.
Conclusion:
Long-term cognitive performance remained stable in most patients receiving percutaneous valve despite the high intrinsic risk of this population.
Editorial Comment
Cognitive function consists of multiple parts (ie. Language, memory, etc.), each must be evaluated for a specific test, making it quite cumbersome to find subtle differences. Patients usually get tired after performing the first tests which might decrease their performance at least; in fact the attention is one of the functions to be evaluated. This study, conducted at a single center and with relatively few patients, does not seem to close the case with regard to the association between stroke and cognition.
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