Intraoperative Cerebral Perfusion Disturbances During Transcatheter Aortic Valve Replacement

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Fanning, Jonathon P
Walters, Darren L
Wesley, Allan J
Anstey, Chris
Huth, Samuel
Bellapart, Judith
Collard, Caroline
Rapchuk, Ivan L
Natani, Sarvesh
Savage, Michael
Fraser, John F
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2017
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Abstract

Background: Transcatheter aortic valve replacement entails profound and unavoidable hemodynamic perturbations that may contribute to the neurological injury associated with the procedure. Methods: Thirty-one patients were monitored with cerebral oximetry as a surrogate marker of perfusion while undergoing transcatheter aortic valve replacement via a transfemoral approach under general anesthesia to detect intraoperative hypoperfusion insult. Serial neurologic, cognitive, and cerebral magnetic resonance imaging assessments were administered to objectively quantify perioperative neurologic injury and ascertain any association with significant cerebral oximetry disturbances. Results: Cerebral oximetry reacted promptly to rapid ventricular pacing with significant cerebral desaturation, relative to baseline, of greater than 12% and greater than 20% in 12 of 31 (68%) and 9 of 31 (29%) patients, respectively; or to an absolute measurement of less than 50% in 10 of 31 (33%) patients. Hyperemia occurred immediately following relief of aortic stenosis exceeding baseline by greater than 10% and greater than 20% in 14 of 31 (45%) and 5 of 31 (16%) patients. Postoperative cognitive dysfunction was evident in 3 of 31 (10%) patients and new magnetic resonance imaging–defined ischemic lesions were seen in 17 of 28 (61%) patients. No patient experienced clinically apparent stroke. Conclusions: Cerebral oximetry reacted promptly to rapid ventricular pacing with significant desaturation and hyperemia a common occurrence. However, no association between this intraoperative insult and objective neurologic injury was detected.

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Annals of Thoracic Surgery

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104

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5

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Subject

Cardiovascular medicine and haematology

Clinical sciences

Science & Technology

Life Sciences & Biomedicine

Cardiac & Cardiovascular Systems

Respiratory System

Surgery

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Fanning, JP; Walters, DL; Wesley, AJ; Anstey, C; Huth, S; Bellapart, J; Collard, C; Rapchuk, IL; Natani, S; Savage, M; Fraser, JF, Intraoperative Cerebral Perfusion Disturbances During Transcatheter Aortic Valve Replacement, Annals of Thoracic Surgery, 2017, 104 (5), pp. 1564-1568

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