Clinical and neurocognitive outcomes in patients with supra-arch vascular disease following transcatheter aortic valve replacement

Abstract

Abstract Background Symptomatic carotid, vertebral and subclavian artery stenosis are associated with the risk of stroke, but the impact of these supra-arch vascular diseases (SAVD) on clinical and neurocognitive outcomes following transcatheter aortic valve replacement (TAVR) is unclear. Methods Preoperative carotid/vertebral duplex ultrasonography and computed tomography were performed to identify the presence of SAVD. Prospective neurological assessments (Barthel Index), global cognitive tests (Mini-Mental State Examination, MMSE) and executive performances (Color Trail Test A and B and verbal fluency), were applied at baseline, 3 months and 1 year post-TAVR. Results Overall, a total of 210 patients were evaluated, and 59 patients (28.1%) had SAVD (carotid stenosis: 37, vertebral stenosis: 23, subclavian stenosis: 6). The patients with SAVD were older (84.0±5.7 vs 79.4±8.2, P=0.0001) and had higher incidence of prior stroke or transient ischemic accident (15.3% vs 5.9%, P=0.031). There was no association between the presence of SAVD and stroke (adjusted hazard ratio (aHR): 1.26; 95% confidence interval (95% CI): 0.217-7.341) or mortality (aHR, 1.38; 95% CI:0.834-2.813). After propensity score matching in patients complete neurocognitive assessment after TAVR, the baseline neurocognitive performance were similar between the patients with (N=44) and without SAVD (N=74). Persistent improvement up to 1 year in Barthel Index, MMSE, Color Trail Test A and B could be observed only in the patients without SAVD, but not in patients with SAVD. Conclusions The presence of SAVD was not associated with an increased risk of post-TAVR stroke or mortality. However, the persistent improvement in neurocognitive assessments after TAVR could only be seen in patients without SAVD.