Use this URL to cite or link to this record in EThOS: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.686423
Title: Incidence and mechanisms of cerebral ischaemia following transcatheter aortic valve implantation compared with surgical aortic valve replacement
Author: Alassar , Aiman
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2013
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Abstract:
Background The most likely mechanisms of neurological injury following transcatheter aortic valve implantation (TA VI) and aortic valve replacement (A VR) are cerebral embolisation and hypoperfusion. Primary aim was to compare the potential mechanisms of neurological injury following TA VI and A YR. Methods 127 consecutive high risk patients with severe aortic stenosis who underwent TA VI (n=85) or A VR (n=42) were studied. Transcranial Doppler (TCD), cerebral oximetry, diffusion-weighted MRI (DW -MRI) (before, 6 days and 3 months following procedure) and neurocognitive assessment before and at 3 months were perfonned. Results Neurological injury was not significantly different between TA VI and AVR at one (1.1 % vs. 2.2%, p=0.25) and three months (4.7% vs. 2.2%, p= 1). At 3 months, overall cognitive score was higher in A VR compared with TA VI when adjusted for baseline score; the estimated difference between groups was 0.63 (95% Cl 0.87 - 1.17; p=0.02). Cerebral embolic load was 212 (123-344) during A VR and 134 (76-244) during TAVI, (p=0.07). Cerebral oxygen de saturation during AVR (7.56 ± 2.16) was higher compared to TAVI (5.93 ± 2.47) (p<0.01). Ischemic lesions measured by DW-MRI occurred in 76% ofTAVI and 71% of AVR patients at 6 days (p=0.69) and 63% and 39% at 3 months (p= 0.11). No significant association was found between cerebral emboli, cerebral oxygen desaturation, brain ischemic lesions and general cognitive score. Copclusions At 3 months follow-up, overall cognitive score was higher in A VR compared to TA VI, adjusted for baseline score. However, there was no difference in cerebral embolic load, ischemic lesions and oxygen desaturation.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.686423  DOI: Not available
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