Clinical and Neurocognitive outcomes after Transcatheter Aortic Valve Implantation (TAVI) with cerebral protection: Initial Experience with a novel dual-filter device in Southeast Asia
Chiam PT, Chan NS, Lim YT, Lim CP, Nair D, Lim TT, Soon CY, Khoo BCH, Lim J, Tan KS, Lam L, Yan P, Ooi YW, Chong MS
Singapore Med Journal 2022 Feb 24. doi: 10.11622/smedj.2022030. Online ahead of print.
Introduction: Transcatheter aortic valve implantation (TAVI) is increasingly performed in patients with severe aortic stenosis. A novel dual-filter system to reduce cerebral embolism during TAVI recently became available. We aimed to assess the feasibility, safety, and clinical and neurocognitive outcomes of TAVI with cerebral protection in Asian patients.
Methods: 40 consecutive patients undergoing TAVI with cerebral protection were enrolled. All procedures were performed via femoral access using the self-expanding Evolut R/PRO or Portico, or the balloon-expandable SAPIEN 3 bioprostheses. Baseline characteristics, procedural and clinical outcomes were recorded. Cognition was assessed at baseline and 30 days using the abbreviated mental test (AMT).
Results: Mean age was 76.4 ± 8.4 years (75.0% were men). TAVI was uncomplicated in all patients. The filter device was successfully deployed in 38 (95.0%) patients without safety issues. There was no stroke or death at 30 days, and survival rate at nine months was 95.0%. There was no overall cognitive change (baseline vs. 30-day AMT: 9.2 ± 1.1 vs. 9.0 ± 1.5, p = 0.12), and only 1 (2.5%) patient developed impaired cognition at 30 days. Patients with a decreased AMT score at 30 days were significantly older than those without (82.1 ± 4.5 vs. 74.4 ± 7.7 years, p = 0.019). All patients with decreased AMT scores were ≥ 76 years.
Conclusion: In this early Asian experience of TAVI under cerebral protection, the filter device was successfully deployed in 95% of patients with 100% procedural success. There were no filter-related complications and no stroke or mortality at 30 days. Overall cognition was preserved, although increased age was associated with a decline in AMT score.