Open-heart surgery is still the procedure of choice to replace an aortic valve. But in the past few years the technical improvements in catheter-based devices and the corresponding medical procedures have added to the appeal of the Transcatheter Aortic Valve replacement (TAVI) as a good alternative.Moreover the procedure is preferred for patients considered risky candidates for open-heart surgery with its sequel of complications and long recovery.
A new study from Australia found that every 10 intermediate-risk patients who underwent TAVI for severe aortic stenosis had clinical and radiological evidence of subtle neurologic injury. The study had three major flaws:
- Ten of the forty participants did not have the MRI studies.
- The implantation methods of the catheter varied.
- There was not a control group of patients with open-heart surgery.
TAVI is less invasive—allowing a speedier recovery of most patients—but it has the potential risk of dislodging a plaque or a clot that can travel by the bloodstream to the brain and produce a life-threatening stroke. More often there might be some subclinical neurologic injuries that produce limitations. Investigators do not know if those brain injuries produced by the TAVY are associated with a greater future risk of stroke, dementia and even death.
The choice of TAVI is not without its risks, for which patients must be fully informed of their extent before wilfully signing up for that procedure. No matter how small the strokes are they constitute a higher risk for dementia. In order to prevent these subclinical neurologic injuries during the catheter replacement, devices are being designed in order to capture the small debris.
The SENTINEL study compared the neurological outcomes of intermediate-risk patients who had TAVI with a filtering device to patients who had it without the filtering device. The filter did collect the debris but there was not a significant difference in the cognitive decline between those two groups. Researchers are now planning a bigger study to find a statistical difference.
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