Silent cerebral infarction and cognitive function following TAVI: an observational two-centre UK comparison of the first-generation CoreValve and second-generation Lotus valve.

Autor:	Musa TA; Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK., Uddin A; Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK., Loveday C; Cognitive Science Research Unit, University of Westminster, London, UK., Dobson LE; Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK., Igra M; Interventional Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK., Richards F; Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK., Swoboda PP; Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK., Singh A; Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, University of Leicester, Leicester, UK.; National Institute of Health Research (NIHR) Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK., Garg P; Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK., Foley JRJ; Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK., Fent GJ; Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK., Goddard AJP; Interventional Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK., Malkin C; Interventional Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK., Plein S; Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.; Interventional Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK., Blackman DJ; Interventional Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK., McCann GP; Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, University of Leicester, Leicester, UK.; National Institute of Health Research (NIHR) Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK., Greenwood JP; Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.; Interventional Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2019 Jan 21; Vol. 9 (1), pp. e022329. Date of Electronic Publication: 2019 Jan 21.
DOI:	10.1136/bmjopen-2018-022329
Abstrakt:	Objective: To compare the incidence of silent cerebral infarction and impact on cognitive function following transcatheter aortic valve implantation (TAVI) with the first-generation CoreValve (Medtronic, Minneapolis, Minnesota, USA) and second-generation Lotus valve (Boston Scientific, Natick Massachusetts, USA). Design: A prospective observational study comprising a 1.5 T cerebral MRI scan, performed preoperatively and immediately following TAVI, and neurocognitive assessments performed at baseline, 30 days and 1 year follow-up. Setting: University hospitals of Leeds and Leicester, UK. Patients: 66 (80.6±8.0 years, 47% male) patients with high-risk severe symptomatic aortic stenosis recruited between April 2012 and May 2015. Main Outcome Measures: Incidence of new cerebral microinfarction and objective decline in neurocognitive performance. Results: All underwent cerebral MRI at baseline and immediately following TAVI, and 49 (25 Lotus, 24 CoreValve) completed neurocognitive assessments at baseline, 30 days and 1 year. There was a significantly greater incidence of new cerebral microinfarction observed following the Lotus TAVI (23 (79%) vs 22 (59%), p=0.025) with a greater number of new infarcts per patient (median 3.5 (IQR 7.0) vs 2.0 (IQR 3.0), p=0.002). The mean volume of infarcted cerebral tissue per patient was equivalent following the two prostheses (p=0.166). More patients suffered new anterior (14 (48%) vs 2 (5%), p=0.001) and vertebrobasilar (15 (52%) vs 7 (19%), p=0.005) lesions following Lotus. Lotus was associated with a decline in verbal memory and psychomotor speed at 30 days. However, performance longitudinally at 1 year was preserved in all neurocognitive domains. Conclusions: There was a higher incidence of silent cerebral microinfarction and a greater number of lesions per patient following Lotus compared with CoreValve. However, there was no objective decline in neurocognitive function discernible at 1 year following TAVI with either prosthesis. Competing Interests: Competing interests: DJB and CM are consultants and proctors for both Medtronic and Boston Scientific. JPG and SP have received an educational research grant from Philips Healthcare. (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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