Brain Injury After Transcatheter Replacement of Bicuspid Versus Tricuspid Aortic Valves

An increasing number of bicuspid aortic valve (BAV) patients are undergoing transcatheter aortic valve replacement (TAVR), but the risk of brain injury in diffusion-weighted magnetic resonance imaging (DW-MRI) is currently unknown. This study sought to evaluate the risk of brain injury in BAV patien...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2020-12, Vol.76 (22), p.2579-2590
Main Authors: Fan, Jiaqi, Fang, Xian, Liu, Chunhui, Zhu, Gangjie, Hou, Cody R., Jiang, Jubo, Lin, Xinping, Wang, Lihan, He, Yuxin, Zhu, Qifeng, Ng, Stella, Chen, Zexin, Hu, Haitao, Liu, Xianbao, Wang, Jian’an, Leon, Martin B.
Format: Article
Language:English
Subjects:
Aged
Aortic Valve - diagnostic imaging
Aortic Valve - pathology
Aortic Valve - surgery
Aortic Valve Stenosis - diagnosis
Aortic Valve Stenosis - surgery
bicuspid aortic valve
Bicuspid Aortic Valve Disease - diagnosis
Bicuspid Aortic Valve Disease - surgery
Brain - diagnostic imaging
brain injury
cerebral ischemic lesions
Diffusion Magnetic Resonance Imaging - methods
Diffusion Magnetic Resonance Imaging - statistics & numerical data
Female
Humans
Ischemic Stroke - diagnosis
Ischemic Stroke - etiology
Male
Outcome and Process Assessment, Health Care
Postoperative Complications - diagnosis
Postoperative Complications - etiology
transcatheter aortic valve replacement
Transcatheter Aortic Valve Replacement - adverse effects
Transcatheter Aortic Valve Replacement - methods
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Summary:An increasing number of bicuspid aortic valve (BAV) patients are undergoing transcatheter aortic valve replacement (TAVR), but the risk of brain injury in diffusion-weighted magnetic resonance imaging (DW-MRI) is currently unknown. This study sought to evaluate the risk of brain injury in BAV patients following TAVR. A total of 204 consecutive severe aortic stenosis patients who underwent TAVR were enrolled. A total of 83 (40.7%) patients were BAV patients, and the other 121 patients were tricuspid aortic valve (TAV) patients. All patients received DW-MRI at baseline, and after TAVR. Median ages (76 years [interquartile range (IQR): 71 to 81 years] vs. 79 years [IQR: 74 to 83 years]; p = 0.004) and Society of Thoracic Surgeons scores (4.87 [IQR: 3.72 to 8.54] vs. 6.38 [IQR: 3.96 to 9.50]; p = 0.044) of the BAV and TAV patients were significantly different, while the overt stroke rates (2.4% vs. 1.7%; p = 0.704) were comparable between the 2 groups. BAV patients were associated with higher number of new lesions (4.0 [IQR: 1.0 to 8.0] vs. 2.0 [IQR: 1.0 to 5.0]; p = 0.008), total lesion volume (290 mm3 [IQR: 70 to 930 mm3] vs. 140 mm3 [IQR: 35 to 480 mm3]; p = 0.008), and the volume per lesion (70.0 mm3 [IQR: 45.0 to 115.0 mm3] vs. 57.5 mm3 [IQR: 24.5 to 93.0 mm3]; p = 0.037) in DW-MRI. Moreover, the proportion of patients with lesions larger than 1 cm3 (28.6% vs. 10.9%; p = 0.005) was higher in BAV patients than in TAV patients. BAV patients may encounter more severe brain injuries not only due to greater number of lesions, but also due to larger lesion size in the early phase after TAVR. (Transcatheter Aortic Valve Replacement Single Center Registry in Chinese Population [TORCH]; NCT02803294) [Display omitted]
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2020.09.605