Impact of repositioning on brain injury following transcatheter aortic valve replacement with a self-expanding valve

• Published in: Scientific reports 2024-07, Vol.14 (1), p.17554-10, Article 17554
• Main Authors: Fan, Jiaqi, Chen, Jun, Zhu, Gangjie, Xu, Yeming, Ng, Stella, Dai, Hanyi, Zhou, Dao, Yidilisi, Abuduwufuer, Qi, Xinrui, Liu, Xianbao, Wang, Jian’an
• Format: Article
• Language: English
• Subjects: 692/4019/2776; 692/499; Aged; Aged, 80 and over; Aortic valve; Aortic Valve - diagnostic imaging; Aortic Valve - pathology; Aortic Valve - surgery; Aortic Valve Stenosis - surgery; Brain Injuries - diagnostic imaging; Brain Injuries - etiology; Brain injury; Cerebral ischemic lesions; Diffusion Magnetic Resonance Imaging; Female; Heart Valve Prosthesis - adverse effects; Humanities and Social Sciences; Humans; Incidence; Ischemia; Lesions; Magnetic resonance imaging; Male; multidisciplinary; NCT; NCT02803294; Neuroimaging; Recapture; Repositioning; Risk Factors; Science; Science (multidisciplinary); Self-expanding valve; Sensitivity analysis; Stroke; Stroke - etiology; Transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - methods; Traumatic brain injury
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-024-67748-6

Repositionable self-expanding valves allow for repositioning during deployment to achieve optimal valve placement. However, the risk of brain injury associated with repositioning, as detected by diffusion-weighted magnetic resonance imaging (DW-MRI), is unknown. Consecutive patients undergoing transcatheter aortic valve replacement (TAVR) with repositionable self-expanding valves and receiving DW-MRI before and within 7 days post-TAVR procedure were included. The primary outcomes were incidence, number, total volume, and volume per lesion of the cerebral ischemic lesion in DW-MRI after TAVR. Univariate and multivariate logistic regression assessed the association between repositioning and bigger total lesion volume (> 1 cm 3 or > 0.5 cm 3 ). Negative binomial regressions were performed to explore the association between repositioning and number of lesions. A propensity score matching was performed to adjust the potential confounders. Moreover, inverse probability of treatment weighted regression model with nonstabilized weights was used as sensitivity analysis. Among 243 included patients, repositioning was performed in 116 (47.7%) patients. The incidence of overt stroke (1.7% vs. 1.6%, p  = 0.927) and silent stroke (86.2% vs. 85.8%, p  = 0.932) were comparable between two groups. However, the number of new lesions (5.0 [2.0–9.0] vs. 3.0 [2.0–6.0], p  = 0.048), and total lesion volume (275.0 [90.0–947.5] mm 3 vs. 180.0 [50.0–440.0] mm 3 , p  = 0.022) were significantly higher in the repositioned group. Moreover, the proportion of patients with lesion size greater than 0.5 cm 3 was higher in the repositioned group (37.9% vs. 22.0%, p  = 0.007). The similar results were observed after propensity score matching. In both multivariate regression model and sensitivity analysis, the repositioning was the independent predictor of number of lesions and bigger total lesion volume after TAVR. The utilization of the repositioning feature may increase the number and volume of silent brain infarcts in DW-MRI in patients who underwent TAVR. (Transcatheter Aortic Valve Replacement Single Center Registry in Chinese Population [TORCH]; NCT02803294)