Claas Philip Naehle MD, Presenter: Nothing to Disclose

Andreas Mueller MD, PhD, Abstract Co-Author: Nothing to Disclose

Alexander Ghanem, Abstract Co-Author: Nothing to Disclose

Fritz Mellert, Abstract Co-Author: Nothing to Disclose

Georg Nickenig, Abstract Co-Author: Nothing to Disclose

Hans H. Schild MD, Abstract Co-Author: Nothing to Disclose

Daniel K.H. Thomas MD, Abstract Co-Author: Nothing to Disclose

00030490-DMT et al, Abstract Co-Author: Nothing to Disclose

To compare the incidence of silent and apparent cerebral embolism after conventional and non-invasive transfemoral aortic valve replacement (AVR).

To date 23 patients were included prospectively into the study. Aortic valve repair (AVR) was performed in 13 patients by conventional technique and in 10 patients using a transfemoral approach. Before the intervention CT of the chest was performed preoperatively to assess the degree of aortic and aortic valve calcification. Patients underwent MRI of the brain, including diffusion weighted imaging (DWI) and neurological assessment (NIHSS score) within 48 h before and after the procedure to assess ocurrence of cerebral embolism.

8 /10 patients (80%) in the transfemoral group but only 5/13 (38.5%) patients in the conventional AVR group had focal DWI abnormalities, indicating acute cerebral embolic events. In addition, patients who underwent transfemoral AVR showed significantly more focal DWI abnormalities than patients who underwent conventional AVR (5.78±6.11, range 0-21 vs. 0.625±0.86, range 0-2; p<0.05). 4/10 patients (40%) in the transfemoral group had territorial DWI abnormalities indicating acute cerebral infarction while these were seen in only 1o f 13 (7.7%) patients in the conventional group. Again, patients who underwent transfemoral AVR showed significantly more territorial lesions thank patients who underwent conventional AVR (1.75±1.30, range 1-4 vs. 0.143±0.35, range 0-1; p<0.05). Although NIHSS scores did not differ significantly between the conventional group and the transfemoral group (1.72±4.59 vs. 0.0±0.0, p=0.4807), 1 patient in the transfemoral (7.7%) group was clinically severely impaired by a territorial stroke (NIHSS score 13) vs. no clinical impairment in the conventional group. No significant difference in the degree of aortic and aortic valve calcification was noted between both groups (p=0.1143).

According to this preliminary data, focal and territorial cerebral infarctions occurred more frequently in patients undergoing transfemoral AVR compared to conventional AVR.

Cerebral embolism appears to be more frequent after transfemoral compared to conventional AVR - further studies are necessary before transfemoral AVR can be recommended for unselected patient groups.

Naehle, C, Mueller, A, Ghanem, A, Mellert, F, Nickenig, G, Schild, H, Thomas, D, et al, 0, Incidence and Severity of Silent and Apparent Cerebral Embolism after Conventional and Minimally Invasive Transfemoral Aortic Valve Replacement.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8008650.html