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The International Journal of Cardiovascular Imaging

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26-06-2023 | Transcatheter Aortic Valve Implantation | Original Paper

Direct transcatheter aortic valve implantation (TAVI) decreases silent cerebral infarction when compared to routine balloon valvuloplasty

Authors: Uğur Arslan, Güney Erdoğan, Mustafa Yenerçağ, Gökhan Aksan, Melisa Uçar, Selim Görgün, Çetin Kürşat Akpinar, Onur Öztürk, Osman Can Yontar, Ahmet Karagöz

Published in: The International Journal of Cardiovascular Imaging | Issue 10/2023

Abstract

Purpose: Silent cerebral infarctions (SCI), as determined by neuron-specific enolase (NSE) elevations, may develop after the transcatheter aortic valve implantation (TAVI) procedure. Our aim in this study was to compare the SCI rates between patients who underwent routine pre-dilatation balloon aortic valvuloplasty (pre-BAV) and patients who underwent direct TAVI without pre-BAV. Methods: A total of 139 consecutive patients who underwent TAVI in a single center using the self-expandable Evolut-R valve (Medtronic, Minneapolis, Minnesota, USA) were included in the study. The first 70 patients were included in the pre-BAV group, and the last 69 patients were included in the direct TAVI group. SCI was detected by serum NSE measurements performed at baseline and 12 h after the TAVI. New NSE elevations > 12 ng/mL after the procedure were counted as SCI. In addition, SCI was scanned by MRI (magnetic resonance imaging) in eligible patients. Results: TAVI procedure was successful in all of the study population. Post-dilatation rates were higher in the direct TAVI group. Post-TAVI NSE positivity (SCI) was higher in the routine pre-BAV group (55(78.6%) vs. 43(62.3%) patients, p = 0.036) and NSE levels were also higher in this group (26.8 ± 15.0 vs. 20.5 ± 14.8 ng/ml, p = 0.015). SCI with MRI was found to be significantly higher in the pre-BAV group than direct TAVI group (39(55.1%) vs. 31(44.9%) patients). The presence of atrial fibrillation and diabetes mellitus (DM), total cusp calcification volume, calcification at arcus aorta, routine pre-BAV and failure at first try of the prosthetic valve implantation were significantly higher in SCI (+) group. In the multivariate analysis, presence of DM, total cusp calcification volume, calcification at arcus aorta, routine pre-BAV and failure at first try of the prosthetic valve implantation were significantly associated with new SCI development. Conclusions: Direct TAVI procedure without pre-dilation seems to be an effective method and avoidance of pre-dilation decreases the risk of SCI development in patients undergoing TAVI with a self-expandable valve.

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Title: Direct transcatheter aortic valve implantation (TAVI) decreases silent cerebral infarction when compared to routine balloon valvuloplasty
Authors: Uğur Arslan
Güney Erdoğan
Mustafa Yenerçağ
Gökhan Aksan
Melisa Uçar
Selim Görgün
Çetin Kürşat Akpinar
Onur Öztürk
Osman Can Yontar
Ahmet Karagöz
Publication date: 26-06-2023
Publisher: Springer Netherlands
Keywords: Transcatheter Aortic Valve Implantation
Valvuloplasty
Valvuloplasty
Valvuloplasty
Diabetes
Published in: The International Journal of Cardiovascular Imaging / Issue 10/2023
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-023-02895-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Direct transcatheter aortic valve implantation (TAVI) decreases silent cerebral infarction when compared to routine balloon valvuloplasty

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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