Silent stroke is common after transcatheter aortic valve replacement (TAVR). Co-morbidities such as diabetes or chronic renal failure, as well as procedural factors such as pre-dilation, increase the risk of silent stroke.
While many events of silent stroke have an early effect on cognition, it is necessary to learn whether the impairment is sustained over time—specially in lower-risk populations with longer life expectancy. Cerebral protection devices do not seem to significantly reduce the issue.
In this paper, a systematic search of every study reporting the incidence of silent cerebral lesions detected in post-TAVR diffusion MRI was conducted. The amount of new silent lesions, baseline characteristics of patients, and incidence of early cognitive impairment were evaluated.
A total of 39 studies with said characteristics were identified. They included over 2000 patients who met inclusion criteria and had undergone a diffusion MRI after TAVR.
Surprisingly, 1601 patients experienced at least one new silent cerebral lesion. However, the clinical significance of these new lesions only reached 3%.
The analysis of co-morbidities analysis showed that diabetes, chronic renal failure, evaluations with 3T equipment, and pre-dilation were associated with a higher risk of silent imaging.
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Prevalence of early cognitive impairment at one-year rose from 16% at 10.0 ± 6.3 days to 26% at 6.1 ± 1.7 months. The number of new silent cerebral lesions was also linked to early cognitive impairment, evidencing an association between the mean number of silent lesions and the incidence of impairment.
Using different cerebral protection devices during the procedure seems to reduce the number of lesions, but not the incidence of cognitive impairment.
Conclusion
Post-TAVR silent stroke is a common event. Co-morbidities such as diabetes and pre-dilation increase the chances of its occurrence.
While more new lesions negatively impact impairment, longer-term follow-up is needed to expand in younger populations. The use of brain protection devices does not seem to be clinically useful.
ehab002freeOriginal Title: Silent brain infarcts and early cognitive outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis.
Reference: Kei Woldendorp et al. European Heart Journal (2021) 42, 1004–1015 doi:10.1093/eurheartj/ehab002.
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