Embolic cerebral insults after transapical aortic valve implantation detected by magnetic resonance imaging

Martin Arnold*, Susanne Schulz-Heise, Stephan Achenbach, Sabine Ott, Arnd Drfler, Dieter Ropers, Richard Feyrer, Friedrich Einhaus, Sabrina Loders, Faidi Mahmoud, Olaf Roerick, Werner G. Daniel, Michael Weyand, Stephan M. Ensminger, Josef Ludwig

*Corresponding author for this work
82 Citations (Scopus)


Objectives This study assessed the rate of periprocedural embolic ischemic brain injury during transapical aortic valve replacement in 25 consecutive patients. Background Transcatheter aortic valve implantation is rapidly being established as a new therapeutic approach for aortic valve stenosis. Although initial clinical results are promising, it is unknown whether mobilization and embolization of calcified particles may lead to cerebral ischemia. Methods Twenty-five consecutive patients (10 men, 15 women, mean age: 81 ± 5 years, mean log EuroSCORE [European System for Cardiac Operative Risk Evaluation]: 32 ± 10%) scheduled for transapical aortic valve implantation were included. All patients received a baseline cerebral magnetic resonance imaging scan. The scan was repeated approximately 6 days after valve implantation. The magnetic resonance imaging studies included axial diffusionweighted, T2-weighted, fluid attenuated inversion recoveryweighted, and T2 gradient echo sequences. Standardized assessment of the neurologic status was performed before aortic valve replacement and post-operatively. Results Transapical aortic valve implantation was successfully performed in all patients. In 17 patients (68%), new cerebral lesions could be detected, whereas 8 patients showed no new cerebral insults. The pattern of distribution and morphology were typical of embolic origin. Despite the high incidence of morphologically detectable lesions, only 5 patients showed clinical neurologic alterations. Out of these patients, only 1 suffered from a permanent stroke. Conclusions New embolic ischemic cerebral insults are detected in 68% of patients after transapical valve implantation. Clinical symptoms are rare and usually transitory. Larger trials will need to establish the clinical significance of asymptomatic ischemic lesions as well as the rate of ischemic events in patients undergoing transfemoral valve replacement.

Original languageEnglish
JournalJACC: Cardiovascular Interventions
Issue number11
Pages (from-to)1126-1132
Number of pages7
Publication statusPublished - 11.2010


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