Edge-to-edge repaire and the incidence of silent cerebral embolic events

Abstract

Abstract Background Silent cerebral hits are present in the majority of patients (75-80%) undergoing TAVI. However, there is a lack of data on the rate of silent cerebral infarcts after percutaneous "edge-to-edge" procedure. Purpose To assess clinically overt stroke and silent cerebral embolic lesions detected by diffusion-weighted magnetic resonance imaging (DW-MRI) in patients after MitraClip implantation. Methods and results 85 patients underwent MitraClip implantation at our institution within a period of May 2016 – January 2023. Of these, 53 patients (62%) underwent DW-MRI pre (<24 hours) and post (24-48 hours) "edge-to-edge" procedure. No patients showed a significant decline in post-neurocognitive function (as assessed by the Montreal Cognitive Assessment [MoCA] score) compared with baseline. DW-MRI detected silent cerebral lesion in 11 patients (21%; 6 unilateral and 5 bilateral) after MitraClip implantation. Conclusions The rate of silent (assessed by DW-MRI) cerebral embolic events after MitraClip implantation was very low in our observational study (the largest study worldwide so far). Larger randomized trials including neuroimaging are needed to define the occurrence and consequences of cerebral damage during transcatheter treatment of mitral regurgitation. Future research is also needed to investigate the role of cerebrovasczlar protection devices during this procedure.