Transcatheter aortic valve replacement: perioperative stroke and beyond

Area of Science:

• Neurology and Cardiology
• Medical Imaging and Diagnostics
• Interventional Cardiology

Background:

• Stroke definitions have evolved from clinical diagnosis to incorporating imaging criteria, notably with magnetic resonance imaging (MRI).
• Transcatheter aortic valve replacement (TAVR) procedures are increasingly common in high-risk patients with severe aortic stenosis.
• The rise in TAVR necessitates a re-evaluation of perioperative stroke diagnosis, interpretation, and significance.

Purpose of the Study:

• To summarize the evolving definitions and diagnostic criteria for stroke and transient ischemic attacks.
• To examine the impact of MRI and cognitive tests on understanding TAVR procedure safety.
• To review evidence on cerebral protection technology's role in TAVR and its effect on cognitive function.

Main Methods:

• Review of current literature on stroke definitions and diagnostic advancements.
• Analysis of magnetic resonance imaging (MRI) and standardized cognitive testing in TAVR patient populations.
• Examination of research on cerebral protection devices during TAVR.

Main Results:

• Widespread MRI use has shifted stroke diagnosis towards integrated clinical and imaging criteria.
• MRI and cognitive tests provide a more nuanced understanding of TAVR safety and potential neurological events.
• Evidence is growing regarding the efficacy of cerebral protection technology in mitigating cognitive decline post-TAVR.

Conclusions:

• Standardized MRI protocols are essential for accurate recognition of post-TAVR neurological events.
• Prospective evaluation using cognitive assessment batteries is crucial for confirming TAVR safety.
• Further research is needed to confirm the effectiveness of embolic protection technology in TAVR procedures.