Cerebral outcomes in patients undergoing transcatheter aortic valve implantation

Aortic valve stenosis causes significant morbidity and mortality, improving after transcatheter aortic valve implantation. Patients undergoing TAVI may either experience an improvement or a deterioration of cerebral perfusion. In this thesis we examined the incidence of TAVI related stroke across the globe over the last decade and examined whether TAVI related stroke as well as new cerebral white matter lesions (representing chronic cerebrovascular damage), could be predicted. We found that the incidence of TAVI related stroke was 2.4% and did not reduce over the last decade, despite a reduction in all other procedural complications. We found that patients with a larger calcification volume of the aortic valve, patients treated with self-expandable valves and patients older than 90 years or a prior stroke had a higher risk of cerebral infarction. We described that use of cerebral protection devices, placed in the aortic arch during the TAVI procedure, may reduce cerebral infarction and accordingly improve cerebral outcomes.
On the other hand, a proportion of the patients experiences cognitive improvement after TAVI, potentially due to improved cerebral perfusion. In this thesis we examined whether an improvement of cardiac output after TAVI was related to an increase in cerebral blood flow. We found that every additional liter of cardiac output after TAVI was related to an 8% increase in cerebral blood flow from baseline. Following the results from the current thesis, our study team will investigate whether improved cerebral blood flow following TAVI is associated with improved cognitive functioning in a consecutive large-scale observational trial.