IMPACT OF DURATION OF TRANSCATHETER AORTIC VALVE IMPLANTATION ON NEUROPHYSIOLOGICAL OUTCOMES OF PATIENTS AFTER THE INTERVENTION

Highlights

For the first time we have established an association between a prolonged duration of aortic valve implantation and deterioration of memory and attention, as well as a lower frequency of alpha activity, which indicates adverse changes in neural network activity.

Abstract

Aim. To examine the neurophysiological parameters of patients who underwent transcatheter aortic valve implantation (TAVI), taking into account the intervention's duration.

Methods. The prospective study involved 53 patients, 13 of whom were men. All patients were divided into two groups depending on the duration of TAVI: up to 90 min (n = 21) and more than 90 min (n = 32). To determine the state of brain function in patients who underwent TAVI, preoperative cognitive screening, extended neuropsychological testing to determine postoperative cognitive dysfunction (POCD), and electroencephalographic (EEG) study 1–2 days before and 5–7 days after TAVI were conducted.

Results. The majority of patients (83%) had a decreased preoperative cognitive status (36% severe, 47% moderate cognitive impairment). Extended neuropsychological testing at 5–7 days after TAVI demonstrated that the patients with a longer TAVI time had worse adaptation and greater exhaustion of the directed attention system, and remembered fewer words than the patients with an intervention time of less than 90 minutes. The patients with a longer TAVI time had a lower central frequency of EEG activity (alpha peak) at 5–7 days after TAVI than those with a shorter intervention time. The duration of TAVI has a statistically significant negative correlation with the central frequency of EEG activity.

Conclusion. The results of the study demonstrated the significance of TAVI duration as a complex indicator, possibly associated with the features of the intervention, such as mechanisms of material embolism and impaired cerebral perfusion. The identification of specific perioperative factors and mechanisms that contribute to brain damage and POCD should be the focus of further investigation into TAVI patients' neurophysiological state.

1. Dautzenberg L, Pals J.E.M., Lefeber G.J., Stella P.R., Abawi M., Emmelot-Vonk M., Koek H.L. Predictors of clinical outcome following transcatheter aortic valve implantation: a prospective cohort study. Open Heart. 2021;8(2):e001766. doi: 10.1136/openhrt-2021-001766.

2. Protopopov A.V., Ganjukov V.I., Tarasov R.S. Transcatheter interventions for heart valve pathology. Krasnojarsk: Verso, 2021. 528 s. (In Russian)

3. Seeger J., Virmani R., Romero M., Gonska B., Rottbauer W., Wöhrle J. Significant Differences in Debris Captured by the Sentinel Dual-Filter Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement Among Different Valve Types. JACC Cardiovasc Interv. 2018;11(17):1683-1693. doi: 10.1016/j.jcin.2018.06.018.

4. Zhang D., Dai X., Wang C., Han K., Wang J., Dong Y., Chen J., Hou L. Aortic valve calcification and risk of stroke: A systematic review and meta-analysis. J Clin Neurosci. 2018;55:32-37. doi: 10.1016/j.jocn.2018.07.016.

5. Pagnesi M., Martino E.A., Chiarito M., Mangieri A., Jabbour R.J., Van Mieghem N.M., Kodali S.K., Godino C., Landoni G., Colombo A., Latib A. Silent cerebral injury after transcatheter aortic valve implantation and the preventive role of embolic protection devices: A systematic review and meta-analysis. Int J Cardiol. 2016;221:97-106. doi: 10.1016/j.ijcard.2016.06.143.

6. Vlastra W., van Nieuwkerk A.C., Bronzwaer A.G.T., Versteeg A., Bron E.E., Niessen W.J., Mutsaerts H.J.M.M., van der Ster B.J.P., Majoie C.B.L.M., Biessels G.J., Nederveen A.J., Daemen M.J.A.P., van Osch M.J.P., Baan J., Piek J.J., Van Lieshout J.J., Delewi R. Cerebral Blood Flow in Patients with Severe Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation. J Am Geriatr Soc. 2021 ;69(2):494-499. doi: 10.1111/jgs.16882.

7. Arefayne N.R., Berhe Y.W., van Zundert A.A. Incidence and Factors Related to Prolonged Postoperative Cognitive Decline (POCD) in Elderly Patients Following Surgery and Anaesthesia: A Systematic Review. J Multidiscip Healthc. 2023;16:3405-3413. doi: 10.2147/JMDH.S431168.

8. Zozulya M.V., Lenkin A.I., Kurapeev I.S., Lebedinskii K.M. Postoperative cognitive disorders: the pathogenesis, methods of prevention and treatment. Russian Journal of Anesthesiology and Reanimatology. 2019;(3):25 33. doi: 10.17116/anaesthesiology201903125 (In Russian)

9. Abdul-Jawad Altisent O., Ferreira-Gonzalez I., Marsal J.R., Ribera A., Auger C., Ortega G., Cascant P., Urena M., Del Blanco B.G., Serra V., Sureda C., Igual A., Rovira A., González-Alujas M.T., Gonzalez A., Puri R., Cuellar H., Tornos P., Rodés-Cabau J., Garcia-Dorado D. Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients. Clin Res Cardiol. 2016;105(6):508-17. doi: 10.1007/s00392-015-0946-9.

10. Tarasova I.V., Tarasov R.S., Syrova I.D., Sosnina A.S., Kupriyanova D.S., Kolesnikov A.Yu., Trubnikova O.A., Ganyukov V.I. Clinical and neurophysiological outcomes of transcatheter aortic valve implantation. Clinical and Experimental Surgery. Petrovsky Journal. 2023; 11 (3): 57–67. doi: 10.33029/2308-1198-2023-11-3-57-67. (In Russian)

11. Schoenenberger A.W., Zuber C., Moser A., Zwahlen M., Wenaweser P., Windecker S., Carrel T., Stuck A.E., Stortecky S. Evolution of Cognitive Function After Transcatheter Aortic Valve Implantation. Circ Cardiovasc Interv. 2016;9(10):e003590. doi: 10.1161/CIRCINTERVENTIONS

12. Olszewska-Turek K., Tokarek T., Dziewierz A., Rajtar-Zembaty A., Partyński B., Sorysz D., Dariusz Dudek, Bętkowska-Korpała B. Changes in cognitive functions and quality of life in patients after transcatheter aortic valve implantation. Postepy Kardiol Interwencyjnej. 2020;16(1):82-88. doi: 10.5114/aic.2020.93915.

13. Tarasova I.V., Tarasov R.S., Trubnikova O.A., Ganyukov V.I. The methodological approach to the assessment of the neurophysiological status in patients with transcatheter aortic valve implantation. Complex Issues of Cardiovascular Diseases. 2022;11(2):6-17. doi: 10.17802/2306-1278-2022-11-2-6-16. (In Russian)

14. Besir B., Kapadia S.R. Cerebral Embolic Protection: Is There a Benefit for Left Atrial and Mitral Valve Procedures? Curr Cardiol Rep. 2024;26(12):1341-1346. doi: 10.1007/s11886-024-02132-4.

15. Mangold A.S., Benincasa S., Sanders B.M., Patel K., Mitrev L. Neurological Complications After Transcatheter Aortic Valve Replacement: A Review. Anesth Analg. 2024;139(5):986-996. doi: 10.1213/ANE.0000000000007087.

16. Babiloni C., Blinowska K., Bonanni L, Cichocki A., De Haan W., Del Percio C., Dubois B., Escudero J., et al. What electrophysiology tells us about Alzheimer's disease: a window into the synchronization and connectivity of brain neurons. Neurobiol Aging. 2020;85:58-73. doi: 10.1016/j.neurobiolaging.2019.09.008.

17. Giustiniani A., Danesin L., Bozzetto B., Macina A., Benavides-Varela S, Burgio F. Functional changes in brain oscillations in dementia: a review. Rev Neurosci. 2022;34(1):25-47. doi: 10.1515/revneuro-2022-0010.

18. Pascarella A., Manzo L., Ferlazzo E. Modern neurophysiological techniques indexing normal or abnormal brain aging. Seizure. 2024: S1059-1311(24)00194-8. doi: 10.1016/j.seizure.2024.07.001.

19. Pollari F., Hitzl W., Vogt F., Cuomo M., Schwab J., Söhn C., Kalisnik J.M., Langhammer C., Bertsch T., Fischlein T., Pfeiffer S. Aortic valve calcification as a risk factor for major complications and reduced survival after transcatheter replacement. J Cardiovasc Comput Tomogr. 2020;14(4):307-313. doi: 10.1016/j.jcct.2019.12.001.

20. Maier O., Bosbach G., Piayda K., Afzal S., Polzin A., Westenfeld R., Jung C., Kelm M., Zeus T., Veulemans V. Cerebrovascular Events after Transcatheter Aortic Valve Replacement: The Difficulty in Predicting the Unpredictable. J Clin Med. 2022;11(13):3902. doi: 10.3390/jcm11133902.

21. Fefer P., Bogdan A., Grossman Y., Berkovitch A., Brodov Y., Kuperstein R., Segev A., Guetta V., Barbash I.M. Impact of Rapid Ventricular Pacing on Outcome After Transcatheter Aortic Valve Replacement. J Am Heart Assoc. 2018;7(14):e009038. doi: 10.1161/JAHA.118.009038.

22. Brodt J., Vladinov G., Castillo-Pedraza C., Cooper L., Maratea E. Changes in cerebral oxygen saturation during transcatheter aortic valve replacement. J Clin Monit Comput. 2016;30(5):649-53. doi: 10.1007/s10877-015-9758-8.