Department of Cardiology, University Hospital Erlangen, Erlangen, Germany.
JACC Cardiovasc Interv. 2010 Nov;3(11):1126-32. doi: 10.1016/j.jcin.2010.09.008.
This study assessed the rate of periprocedural embolic ischemic brain injury during transapical aortic valve replacement in 25 consecutive patients.
Transcatheter aortic valve implantation is rapidly being established as a new therapeutic approach for aortic valve stenosis. Although initial clinical results are promising, it is unknown whether mobilization and embolization of calcified particles may lead to cerebral ischemia.
Twenty-five consecutive patients (10 men, 15 women, mean age: 81 ± 5 years, mean log EuroSCORE [European System for Cardiac Operative Risk Evaluation]: 32 ± 10%) scheduled for transapical aortic valve implantation were included. All patients received a baseline cerebral magnetic resonance imaging scan. The scan was repeated approximately 6 days after valve implantation. The magnetic resonance imaging studies included axial diffusion-weighted, T(2)-weighted, fluid attenuated inversion recovery-weighted, and T(2) gradient echo sequences. Standardized assessment of the neurologic status was performed before aortic valve replacement and post-operatively.
Transapical aortic valve implantation was successfully performed in all patients. In 17 patients (68%), new cerebral lesions could be detected, whereas 8 patients showed no new cerebral insults. The pattern of distribution and morphology were typical of embolic origin. Despite the high incidence of morphologically detectable lesions, only 5 patients showed clinical neurologic alterations. Out of these patients, only 1 suffered from a permanent stroke.
New embolic ischemic cerebral insults are detected in 68% of patients after transapical valve implantation. Clinical symptoms are rare and usually transitory. Larger trials will need to establish the clinical significance of asymptomatic ischemic lesions as well as the rate of ischemic events in patients undergoing transfemoral valve replacement.
本研究评估了 25 例连续经心尖主动脉瓣置换术患者围手术期栓塞性缺血性脑损伤的发生率。
经导管主动脉瓣植入术作为一种治疗主动脉瓣狭窄的新方法正在迅速得到确立。尽管最初的临床结果很有希望，但尚不清楚是否会导致钙化颗粒的移动和栓塞导致脑缺血。
25 例连续接受经心尖主动脉瓣置换术的患者（男 10 例，女 15 例，平均年龄：81±5 岁，平均 log EuroSCORE[欧洲心脏手术风险评估系统]：32±10%）被纳入研究。所有患者均接受基线脑部磁共振成像扫描。植入瓣膜后大约 6 天重复进行磁共振成像扫描。磁共振成像研究包括轴向弥散加权、T2 加权、液体衰减反转恢复加权和 T2 梯度回波序列。在主动脉瓣置换术前和术后进行标准化的神经状态评估。
所有患者均成功完成经心尖主动脉瓣置换术。在 17 例患者（68%）中，可检测到新的脑损伤，而 8 例患者无新的脑损伤。分布模式和形态均为栓塞性病变的典型特征。尽管形态上可检测到病变的发生率较高，但仅有 5 例患者出现了临床神经改变。在这些患者中，只有 1 例发生永久性中风。
经心尖瓣膜植入术后，68%的患者出现新的栓塞性缺血性脑损伤。临床症状罕见且通常为一过性。需要进行更大规模的试验来确定无症状性缺血性病变以及接受经股动脉瓣膜置换术的患者发生缺血性事件的发生率的临床意义。
