Comparison of peri-procedural brain lesions by cerebral MRI after transcatheter aortic valve implantation and conventional aortic valve replacement

Aims: Prior studies have shown a high rate of cerebral embolic lesions after transcatheter aortic valve implantation (TAVI). We therefore compared the incidence of ischemic brain lesions and microbleedings with MRI in patients undergoing TAVI and conventional surgical aortic valve replacement.

Methods: 25 consecutive patients (mean age 81 ± 5 years, mean log. EuroScore 32 ± 10%), who underwent TAVI and 25 patients who received surgical aortic valve replacement (AVR) (mean age 77 ± 5 years, mean log. EuroScore 12 ± 6%) were analyzed. Cerebral MRI studies were acquired one day before and within 6 days after the procedure. Standardized neurological assessment was performed preoperatively and every day postoperatively until discharge.

Results: In 68% of the TAVI patients, new cerebral embolic lesions were detected by MRI. The maximum lesion size was < 5 mm in 4 patients, ≤10 mm in 11 patients und > 10 mm in 2 patients. Only one patient suffered from a permanent stroke. In the AVR group, 56% of the patients displayed new embolic lesions. In 4 patients, the maximum size of the lesion was < 5 mm, in 7 patients ≤10 mm and in 3 other patients > 10 mm. No clinical neurological alterations were seen in this group. Differently from the TAVI group in the AVR group, lesions within the border zones of the cerebral arterial perfusion territories and cerebral microbleedings were more frequently seen.

Conclusion: New embolic cerebral lesions could be detected by MRI in the majority of patients after TAVI as well as after AVR. Incidence was lower in the conventional surgical group but did not reach statistical significance. However after AVR increased microbleedings were seen.