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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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| Published in: | Journal of the American College of Cardiology 2020-12, Vol.76 (22), p.2579-2590 |
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| creator | 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. |
| description | 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)
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| doi_str_mv | 10.1016/j.jacc.2020.09.605 |
| format | article |
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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]</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2020.09.605</identifier><identifier>PMID: 33243378</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>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</subject><ispartof>Journal of the American College of Cardiology, 2020-12, Vol.76 (22), p.2579-2590</ispartof><rights>2020 The Authors</rights><rights>Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-5641a7f49af68acceeab9cc302beedbf291f9853eea4fa8d83300368fb43c18c3</citedby><cites>FETCH-LOGICAL-c400t-5641a7f49af68acceeab9cc302beedbf291f9853eea4fa8d83300368fb43c18c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33243378$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fan, Jiaqi</creatorcontrib><creatorcontrib>Fang, Xian</creatorcontrib><creatorcontrib>Liu, Chunhui</creatorcontrib><creatorcontrib>Zhu, Gangjie</creatorcontrib><creatorcontrib>Hou, Cody R.</creatorcontrib><creatorcontrib>Jiang, Jubo</creatorcontrib><creatorcontrib>Lin, Xinping</creatorcontrib><creatorcontrib>Wang, Lihan</creatorcontrib><creatorcontrib>He, Yuxin</creatorcontrib><creatorcontrib>Zhu, Qifeng</creatorcontrib><creatorcontrib>Ng, Stella</creatorcontrib><creatorcontrib>Chen, Zexin</creatorcontrib><creatorcontrib>Hu, Haitao</creatorcontrib><creatorcontrib>Liu, Xianbao</creatorcontrib><creatorcontrib>Wang, Jian’an</creatorcontrib><creatorcontrib>Leon, Martin B.</creatorcontrib><title>Brain Injury After Transcatheter Replacement of Bicuspid Versus Tricuspid Aortic Valves</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>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]</description><subject>Aged</subject><subject>Aortic Valve - diagnostic imaging</subject><subject>Aortic Valve - pathology</subject><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Stenosis - diagnosis</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>bicuspid aortic valve</subject><subject>Bicuspid Aortic Valve Disease - diagnosis</subject><subject>Bicuspid Aortic Valve Disease - surgery</subject><subject>Brain - diagnostic imaging</subject><subject>brain injury</subject><subject>cerebral ischemic lesions</subject><subject>Diffusion Magnetic Resonance Imaging - methods</subject><subject>Diffusion Magnetic Resonance Imaging - statistics & numerical data</subject><subject>Female</subject><subject>Humans</subject><subject>Ischemic Stroke - diagnosis</subject><subject>Ischemic Stroke - etiology</subject><subject>Male</subject><subject>Outcome and Process Assessment, Health Care</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - etiology</subject><subject>transcatheter aortic valve replacement</subject><subject>Transcatheter Aortic Valve Replacement - adverse effects</subject><subject>Transcatheter Aortic Valve Replacement - methods</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kE1Lw0AQhhdRbK3-AQ-So5fE2Ww-dsFLLX4UCoLUelw2m1nckCZ1Nyn035vS1qOnYYbnfWEeQm4pRBRo9lBFldI6iiGGCESUQXpGxjRNechSkZ-TMeQsDSmIfESuvK8AIONUXJIRY3HCWM7H5OvJKdsE86bq3S6Ymg5dsHSq8Vp137jfPnBTK41rbLqgNcGT1b3f2DJYofO9H-DTYdq6zupgpeot-mtyYVTt8eY4J-Tz5Xk5ewsX76_z2XQR6gSgC9MsoSo3iVAm48MziKoQWjOIC8SyMLGgRvCUDffEKF5yxgBYxk2RME25ZhNyf-jduPanR9_JtfUa61o12PZexkmWJizLWTyg8QHVrvXeoZEbZ9fK7SQFuRcqK7kXKvdCJQg5CB1Cd8f-vlhj-Rc5GRyAxwOAw5dbi056bbHRWFqHupNla__r_wWl6ogq</recordid><startdate>20201201</startdate><enddate>20201201</enddate><creator>Fan, Jiaqi</creator><creator>Fang, Xian</creator><creator>Liu, Chunhui</creator><creator>Zhu, Gangjie</creator><creator>Hou, Cody R.</creator><creator>Jiang, Jubo</creator><creator>Lin, Xinping</creator><creator>Wang, Lihan</creator><creator>He, Yuxin</creator><creator>Zhu, Qifeng</creator><creator>Ng, Stella</creator><creator>Chen, Zexin</creator><creator>Hu, Haitao</creator><creator>Liu, Xianbao</creator><creator>Wang, Jian’an</creator><creator>Leon, Martin B.</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20201201</creationdate><title>Brain Injury After Transcatheter Replacement of Bicuspid Versus Tricuspid Aortic Valves</title><author>Fan, Jiaqi ; 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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]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33243378</pmid><doi>10.1016/j.jacc.2020.09.605</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| 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 |
| title | Brain Injury After Transcatheter Replacement of Bicuspid Versus Tricuspid Aortic Valves |
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