Objective: Neurologic complications and neurocognitive impairment due to cerebral emboli are common complications following heart surgery. This study aimed at (i) comparing the number of emboli detected in the middle cerebral artery (MCA) in three procedures: open aortic valve replacement (AVR), apical and femoral trans-catheter aortic valve replacement (TAVR); and (ii) testing an association between the number of emboli captured in each procedure and the changes in the patient’s cognitive state.
Methods Forty-four patients were enrolled in the study, 36 of whom were incorporated in the final analyses. Fourteen patients underwent open-AVR, twelve underwent TAVR-femoral and ten underwent TAVR–apical. The number of emboli was detected by an MCA intraoperative transcranial Doppler ultrasound (TCD) the day before the elective surgery and 6-12 weeks after. All patients underwent neurocognitive evaluations by a Mini Mental Test; their difference (ΔMM) was tested for association with the aforementioned number of emboli.
Results: Open-AVR resulted in a significantly greater number of emboli (8555 [2999, 12489]) compared to either the apical (1962 [4563, 521]) or femoral (1220 [1946, 948]) TAVI approaches (P=0.003). Both TAVI approaches yielded a comparable amount of emboli (P=0.798). No significant association was observed between ΔMM and the mean number of emboli (r=0.026; P=0.907).
Conclusions These findings suggest that, compared to TAVR, more cerebral emboli are detected during AVR procedures; however, they do not seem to have a greater negative effect on the patient’s cognitive state. The TCD technology does not differentiate between solid and gaseous emboli, and the latter is probably more common in open AVR.
