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You are here: Contents > 2013 > Volume 22 Number 1 January 2013 > AORTIC VALVE DISEASE > Cerebral Embolization during Percutaneous Valve Implantation does not Occur during Balloon Inflation Valvuloplasty: Prospective Diffusion-Weighted Brain MRI Study

Cerebral Embolization during Percutaneous Valve Implantation does not Occur during Balloon Inflation Valvuloplasty: Prospective Diffusion-Weighted Brain MRI Study

Parla Astarci, Joel Price, David Glineur, William D’Hoore, Joelle Kefer, Gébrine Elkhoury, Cécile Grandin, Jean-Louis Vanoverschelde

Departments of Cardiovascular Surgery, Cardiology and Radiology, University Hospital Saint-Luc, Brussels, Belgium

Background and aim of the study: The study aim was to define the timing of cerebral embolization events during transcatheter aortic valve implantation (TAVI), and to determine if events were more closely associated with valve implantation or with balloon inflation. Methods: Between January 2008 and November 2011, a total of 114 patients underwent TAVI at the author’s institution. Of these patients, 44 had previously undergone imaging before and after TAVI, and were included in the study (26 transfemoral (TF); 18 transapical (TA)). Eleven patients who had only balloon valvuloplasty (BV) during the same period were included, as were 22 patients who had open aortic valve replacement (AVR), as controls. All 77 patients underwent neurological examination, and all had cerebral MRIs before and after their procedures. Results: Fifty of the 77 patients who underwent post-procedural MRI had new cerebral lesions, as follows:

24/26 (92%) in TF patients; 17/18 (94%) in TA patients; 3/11 (27%) in BV patients; and 6/22 (27%) in AVR patients (TF and TA versus BV and AVR, p <0.0001). The mean number and volume of embolic lesions per patient were respectively 5.4/438 mm³ for TF, 11.6/3414 mm³ for TA, 0.7/46 mm³ for BV, and 0.4/48 mm³ for AVR (TF versus TA and BV versus AVR, p = NS; TF and TA versus BV and AVR, p <0.0001). No association was found between either the EuroSCORE or patient age and the number of events. Conclusion: In the present study, an incidence of silent cerebral embolic lesions after TAVI was identified which was significantly higher than that for BV or AVR. This indicated an association of embolism with valve implantation rather than with balloon inflation.

The Journal of Heart Valve Disease 2013;22:79-84

Cerebral Embolization during Percutaneous Valve Implantation does not Occur during Balloon Inflation Valvuloplasty: Prospective Diffusion-Weighted Brain MRI Study

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