Outcomes after transcatheter aortic valve implantation The brain and beyond

This thesis studies clinical outcomes in patients with severe aortic valve stenosis treated with transcatheter aortic valve implantation (TAVI). The first part focuses on cerebral outcomes. Cognitive impairment is frequent in this patient population. Following TAVI, we observed an overall improvement in cardiac output, cerebral blood flow, and cognitive functioning. Most patients maintained stable cognition, while a substantial subgroup improved, particularly those with lower baseline cognitive scores. However, a proportion experienced cognitive decline, which was associated with new white matter hyperintensities on brain MRI.
The second part addresses clinical outcomes from the international CENTER2 study (n = 25,000). Stroke occurred in 2.1% of patients, with no decline over time, and was strongly associated with increased mortality and morbidity. Underweight patients had a poorer prognosis, whereas overweight did not significantly influence outcomes. Diabetes mellitus had no measurable impact. Both pre-existing and new-onset atrial fibrillation were associated with higher mortality. Major bleeding remained a relevant and relatively common complication; although its incidence decreased over time, it continued to confer an increased mortality risk in the first months after TAVI. Conversion to surgical bailout was rare but severe, with only half of these patients discharged alive. Finally, patients with previously implanted bioprosthetic valves, so-called valve-in-valve TAVI, had outcomes comparable to those undergoing TAVI in a native valve.