Treating Aortic Valve Stenosis for Vitality Improvement: The TAVI Study

医学 心脏病学 内科学 狭窄 经颅多普勒 痴呆 主动脉瓣 主动脉瓣狭窄 认知功能衰退 冲程(发动机) 疾病 外科 机械工程 工程类
作者
Donato Tartaglione,Dario Prozzo,Renatomaria Bianchi,Giovanni Ciccarelli,Maurizio Cappelli Bigazzi,Francesco Natale,Paolo Golino,Giovanni Cimmino
出处
期刊:Diseases [MDPI AG]
卷期号:12 (8): 175-175
标识
DOI:10.3390/diseases12080175
摘要

Background: Degenerative aortic valve stenosis (AS) is the most common valvular heart disease among the elderly. Once cardiac symptoms occur, current guidelines recommend aortic valve replacement. Progressive degeneration/calcification reduces leaflet mobility with gradual cardiac output (CO) impairment. Low CO might induce abnormal brain-aging with cognitive impairment and increased risk of dementia, such as Alzheimer’s disease or vascular dementia. On the contrary, cognitive improvement has been reported in patients in whom CO was restored. Transcatheter aortic valve implantation (TAVI) has proven to be a safe alternative to conventional surgery, with a similar mid-term survival and stroke risk even in low-risk patients. TAVI is associated with an immediate CO improvement, also effecting the cerebrovascular system, leading to an increased cerebral blood flow. The correlation between TAVI and cognitive improvement is still debated. The present study aims at evaluating this relationship in a cohort of AS patients where cognitive assessment before and after TAVI was available. Methods: a total of 47 patients were retrospectively selected. A transcranial Doppler ultrasound (TCD) before and after TAVI, a quality of life (QoL) score, as well as a mini-mental state examination (MMSE) at baseline and up to 36 months, were available. Results: TAVI was associated with immediate increase in mean cerebral flow at TCD. MMSE slowly increase at 36-months follow-up with improved QoL mainly for symptoms, emotions and social interactions. Conclusions: this proof-of-concept study indicates that TAVI might induce cognitive improvement in the long-term as a result of multiple factors, such as cerebral flow restoration and a better QoL.
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