• Minerva anestesiologica · Mar 2018

    Comparative Study Observational Study

    Patterns of changes in functional and neurocognitive status in elderly patients after transcatheter vs surgical aortic valve replacements.

    • Marta Załęska-Kocięcka, Anna Skrobisz, Sebastian Woźniak, Lidia Greszata, Maciej Dąbrowski, Maciej Grabowski, Katarzyna Piotrowska, Anna Konopka, Marek Banaszewski, Anna Mierzyńska, and Janina Stępińska.
    • Intensive Cardiac Care Clinic, Institute of Cardiology, Warsaw, Poland - mzaleska@ikard.pl.
    • Minerva Anestesiol. 2018 Mar 1; 84 (3): 328-336.

    BackgroundReplacement of severely stenotic aortic valve may influence cognitive and physical functioning. The aim of this study was to compare cognitive and functional status after surgical (SAVR) vs. transcatheter aortic valve replacements (TAVR) in the elderly with severe aortic stenosis (AS).MethodsIt was a prospective observational study with over 6 months of follow-up. Eighty ≥70-year-old patients with AS underwent TAVR (N.=40) or SAVR (N.=40). Mini Mental State Exam (MMSE), activities daily living (ADL) score and instrumental activities daily living (IADL) score were used to assess the cognitive status, fundamental functioning and complex independent living skills, respectively. The tests were conducted at baseline and 6 months after the procedure. Additionally, MMSE was carried out at discharge.ResultsBaseline MMSE score was lower in the TAVR vs. SAVR group (P=0.001). In the SAVR group, there was a transient in-hospital decline in mean MMSE score (P=0.020), absent in the TAVR group. Baseline ADL and IADL scores were lower in TAVR patients. Both groups experienced mild improvement. The average increase among those with improved IADL score was larger after TAVR (2.37 vs. 1.37 after SAVR; P=0.029). A systolic blood pressure (SBP) decrease <60 mmHg as well as larger periprocedural shift in SBP (expressed by a difference between maximum and minimum SBP) during TAVR were associated with the decline in the ADL (P=0.001) and IADL scores (P=0.043).ConclusionsCognitive patterns differed between the TAVR and SAVR patients. A transient MMSE decline did not alter the 6-month status. TAVR might improve functionality. Periprocedural SBP decrease and larger changes in SBP are risk factors for functionality deterioration after TAVR.

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