Abstract
ObjectivesThe aim of this study was to quantify potential differences in count, frequency and pattern of high-intensity transient signals (HITS) during transapical transcatheter aortic valve implantation (TA-TAVI), by comparing the Symetis Acurate TA (SA) with the balloon-expandable Edwards Sapien XT (ES) system.BackgroundRecently, the Symetis Acurate TA revalving system has been introduced for TA-TAVI. The Symetis Acurate TA aortic bioprosthesis is self-expanding and is deployed by a specific two-step implantation technique. Whether this novel method increases the load of intraprocedural emboli, detected by transcranial Doppler ultrasound (TCD) as HITS, or not is not clear.MethodsTwenty-two patients (n = 11 in each study arm, median logistic EuroScore 20%, median STS score 7%) displayed continuous TCD signals of good quality throughout the entire TA-TAVI procedure and were included in the final analysis. Data are presented as median with interquartile ranges.ResultsNo significant differences were detected in total procedural or interval-related HITS load (SA: 303 [200; 594], ES: 499 [285; 941]; p = 0.16). With both devices, HITS peaked during prosthesis deployment (PD), whereas significantly fewer HITS occurred during instrumentation (SA: p = 0.002; ES: <0.001) or post-implantation PI (SA: p = 0.007; ES: <0.001). PD-associated HITS amounted to almost half of the total HITS load. One patient suffered new disabling stroke at 30 days. Thirty-day mortality amounted to 13.6% (3 of 22 patients).ConclusionsSimplified transapical delivery using the self-expanding SA device does not increase HITS, despite of a two-step deployment technique with more interactions with the native aortic valve, when compared to the balloon-expandable ES valve. The similarity in HITS count, frequency and pattern with the two systems suggests a common mechanism for the release of cerebral microemboli.
Highlights
In selected high-risk patients with severe aortic valve stenosis, early and late results of the PARTNER trial allow for a direct comparison of event rates of stroke and transient ischemic attack between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) [1,2,3]
high-intensity transient signals (HITS) peaked during prosthesis deployment (PD), whereas significantly fewer HITS occurred during instrumentation (SA: p = 0.002; Edwards Sapien XT (ES):,0.001) or post-implantation post-dilatation maneuvers (PI) (SA: p = 0.007; ES:,0.001)
PDassociated HITS amounted to almost half of the total HITS load
Summary
In selected high-risk patients with severe aortic valve stenosis, early and late results of the PARTNER trial allow for a direct comparison of event rates of stroke and transient ischemic attack between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) [1,2,3]. The passage of stiff guidewires, catheters and the delivery system through the aortic arch (when TAVI is performed via a transfemoral approach) and through the degenerative aortic valve as well as, and balloon aortic valvuloplasty and prosthesis deployment may detach atheromatous or calcified debris, and may cause cerebral microembolization with occasionally devastating complications [4,5,6]. This etiology of intraprocedural stroke is supported by diffusion-weighted magnet resonance imaging (DWMRI) and transcranial Doppler ultrasound (TCD) studies. Whether this novel method increases the load of intraprocedural emboli, detected by transcranial Doppler ultrasound (TCD) as HITS, or not is not clear
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