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OBJECTIVE:
Transcatheter aortic valve implantation (TAVI) is a novel therapy for high risk or inoperable patients with aortic stenosis. Stroke however, remains a significant complication. Transcranial cerebral oximetry (TCO) monitors cerebral oxygenation non-invasively which may be compromised during rapid ventricular pacing (rVP) employed for balloon valvuloplasty (BAV) and valve deployment; a potential cause of stroke. We reviewed the efficacy and significance of TCO monitoring during TAVI.
METHODS:
From 7/2009 to 2/2011, 30 patients underwent TAVI using Edwards and Corevalve platforms. TCO (CAS Medical FORE-SIGHT) continuously monitored regional oxygen saturation (rSO2) of both frontal lobes. Absolute safety threshold was 55%. rVP was conducted at 180 bpm to diminish native systolic ejection
RESULTS:
Mean age was 79±12 years with a male predilection (n=17). Mean Logistic Euroscore was 16±4. TCO signal acquisition was uniformly excellent. Mean duration of rVP was 40±32 seconds for BAV and 17.5±5 seconds for deployment. Mean drop in rSO₂ was 6.1±3.3% during BAV and 3.4±1.3% during deployment. rVP during valve deployment was shorter (p<0.001) and changes in rSO₂ less pronounced compared to valvuloplasty (p<0.001). Baseline rSO₂ recovery occurred 47±25 seconds after termination of rVP. rSO₂ remained above absolute threshold in all cases. One patient died in hospital and no neurological event was observed.
CONCLUSIONS:
Regional cerebral oxygenation reacts promptly to functional circulatory arrest during rapid pacing in TAVI. Reduction in rSO2 was acceptable remaining above safety threshold and displayed rapid recovery. This correlated with an absence of neurological event in our series. Routine TCO during TAVI is recommended to minimize procedural stroke.