Cerebral Blood Flow in Patients with Severe Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 69; no. 2; pp. 494 - 499
• Main Authors: Vlastra, Wieneke, Nieuwkerk, Astrid C., Bronzwaer, Anne‐Sophie G.T., Versteeg, Adriaan, Bron, Esther E., Niessen, Wiro J., Mutsaerts, Henk J.M.M., Ster, Björn J.P., Majoie, Charles B.L.M., Biessels, Geert J., Nederveen, Aart J., Daemen, Mat J.A.P., Osch, Matthias J.P., Baan, Jan, Piek, Jan J., Van Lieshout, Johannes J., Delewi, Ronak
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.02.2021; Wiley Subscription Services, Inc
• Subjects: Aortic stenosis; Aortic valve; Blood flow; Brief Reports; cardiac output; Cerebral blood flow; Cognitive ability; Heart; Magnetic resonance imaging; Quality of life; Regular Issue Content; Spin labeling; Stenosis; Substantia grisea; Transplants & implants; cardiac output; cerebral blood flow; aortic stenosis
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.16882

BACKGROUND Transcatheter aortic valve implantation (TAVI) is a minimally invasive, life‐saving treatment for patients with severe aortic valve stenosis that improves quality of life. We examined cardiac output and cerebral blood flow in patients undergoing TAVI to test the hypothesis that improved cardiac output after TAVI is associated with an increase in cerebral blood flow. DESIGN Prospective cohort study. SETTING European high‐volume tertiary multidisciplinary cardiac care. PARTICIPANTS Thirty‐one patients (78.3 ± 4.6 years; 61% female) with severe symptomatic aortic valve stenosis. MEASUREMENTS Noninvasive prospective assessment of cardiac output (L/min) by inert gas rebreathing and cerebral blood flow of the total gray matter (mL/100 g per min) using arterial spin labeling magnetic resonance imaging in resting state less than 24 hours before TAVI and at 3‐month follow‐up. Cerebral blood flow change was defined as the difference relative to baseline. RESULTS On average, cardiac output in patients with severe aortic valve stenosis increased from 4.0 ± 1.1 to 5.4 ± 2.4 L/min after TAVI (P = .003). The increase in cerebral blood flow after TAVI strongly varied between patients (7% ± 24%; P = .41) and related to the increase in cardiac output, with an 8.2% (standard error = 2.3%; P = .003) increase in cerebral blood flow per every additional liter of cardiac output following the TAVI procedure. CONCLUSION Following TAVI, there was an association of increase in cardiac output with increase in cerebral blood flow. These findings encourage future larger studies to determine the influence of TAVI on cerebral blood flow and cognitive function.