NEW YORK (Reuters Health), Apr 12 - Silent cerebral embolism is common after transfemoral aortic valve implantation, German researchers report in the April 6 Journal of the American College of Cardiology.
"With this study, we wanted to raise awareness of potential complications," lead author Dr. Alexander Ghanem from the University of Bonn, Germany, told Reuters Health by e-mail.
Dr. Ghanem and colleagues investigated the incidence of silent and apparent cerebral emboli in 22 patients (mean age, 79 years) after transfemoral aortic valve implantation. Preoperatively, diffusion-weighted magnetic resonance imaging (MRI) showed that all patients had brain atrophy and hyperintense white matter lesions, but none had any acute ischemic lesions.
Within three days after receiving the new aortic valve, 16 patients (72.7%) had a total of 75 new lesions. Thirty-one of the new lesions (41.3%) were in patients with lacunar defects and old infarcts.
At three months after transfemoral aortic valve placement, three of the 16 patients (18.8%) showed focal signal increases in the region corresponding to the original lesion, indicating the presence of infarcted brain tissue.
Only three patients reported neurological symptoms, including one who developed persistent left-sided hemiparesis. This was the only patient to have significant neurological deficits at three months.
Levels of neuron-specific enolase, a marker of the volume of brain tissue involved in an ischemic event, did not correlate with new lesions.
The prevalence of cerebrovascular and peripheral artery disease and aortic atheroma was slightly higher in patients with embolic lesions, but procedural duration did not differ between patients with and without embolic events.
"The initial idea was to identify independent risk factors for cerebral embolism" related to transfemoral aortic valve implantation, Dr. Ghanem said. "However, the patient number is limited and does not allow a multivariate analysis." He and his colleagues had originally enrolled 30 patients, but only 22 completed the imaging protocol.
The knowledge about silent emboli related to transfemoral aortic valve implantation "could raise awareness for the careful management of peri-interventional anticoagulation," the researchers conclude.
By Will Boggs, M.D.
J Am Coll Cardiol 2010;55:1427-1432.
Last Updated: 2010-04-09 15:12:09 -0400 (Reuters Health)
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