Background: Periprocedural ischemic stroke remains a serious complication in patients undergoing transcatheter aortic valve replacement (TAVR). We used a novel robotic transcranial Doppler (TCD) system equipped with artificial intelligence (AI) for real-time continuous intraoperative neuromonitoring during TAVR to establish the safety and potential validity of this tool in detecting cerebral emboli, report the quantity and distribution of high intensity transient signals (HITS) with and without cerebral protection, and correlate HITS occurrence with various procedural steps.
Methods: Consecutive patients undergoing TAVR procedures during which the robotic system was used between October 2021 and May 2022 were prospectively enrolled in this pilot study. The robotic TCD system included autonomous adjustment of the TCD probes and AI-assisted post-processing of HITS and other cerebral flow parameters. Basic demographics and procedural details were recorded. Continuous variables were analyzed by a two-sample Mann-Whitney t-test and categorical variables by a χ or Fisher test.
Results: Thirty-one patients were prospectively enrolled (mean age 79.9±7.6 years; 16 men (51.6%)). Mean aortic valve stenotic area was 0.7 cm and mean aortic-ventricular gradient was 43 mmHg (IQR 31.5-50 mmHg). Cerebral protection was used in 16 cases (51.6%). Significantly fewer emboli were observed in the protection group than in the non-protection group (mean 470.38 vs 693.33; p=0.01). Emboli counts during valve positioning and implantation were significantly different in the protection and non-protection groups (mean 249.92 and 387.5, respectively; p=0.01). One (4%) transient ischemic attack occurred post-procedurally in the non-protection group.
Conclusion: We describe a novel real-time intraoperative neuromonitoring tool used in patients undergoing TAVR. Significantly fewer HITS were detected with protection. Valve positioning-implantation was the most significant stage for intraprocedural HITS.
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http://dx.doi.org/10.1136/jnis-2023-020812 | DOI Listing |
Circ Cardiovasc Interv
January 2025
Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada. (A.H., J.J., S.O., K.M., J.A.L., P.B., D.A.W., S.L.S., J.G.W., J.S.).
Background: Transcatheter heart valve (THV) underexpansion after transcatheter aortic valve replacement may be associated with worse outcomes. THV expansion can be assessed fluoroscopically using a pigtail for calibration; however, the accuracy of this technique specific to transcatheter aortic valve replacement is unknown. We assessed the accuracy and reproducibility of a novel fluoroscopic method to assess THV expansion using the THV commissural post for calibration.
View Article and Find Full Text PDFInt J Cardiol Heart Vasc
February 2025
Department of Medicine, Lady Davis Carmel Medical Center, Haifa, Israel.
Background: Aortic stenosis (AS) is treated through transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR), with diabetes being prevalent among these patients. Inflammation participates in the pathogenesis of AS, and emerging evidence suggests that TAVI may exert anti-inflammatory effects. Given the established link between diabetes and inflammation, we sought to evaluate the impact of aortic valve replacement (AVR) on glycemic control.
View Article and Find Full Text PDFMonaldi Arch Chest Dis
January 2025
Cardiology Department, Local Health Unit of Alto Ave, Guimarães.
Multivalvular endocarditis (MVE) is an uncommon presentation and mostly involves mitral and aortic valves. Here, we present a case of an MVE with an unusual and bizarre presentation on a Halloween night with a massive degree of valve destruction and right- and left-side involvement requiring emergent surgery. A 51-year-old male patient with intravenous drug usage presented with anorexia, fever, and dyspnea, rapidly progressing to septic shock with multiorgan dysfunction.
View Article and Find Full Text PDFJ Cardiothorac Surg
January 2025
Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79#, Qingchun Road, Hangzhou, 310003, China.
Background: Dextrocardia is a rare cardiac malposition where the heart's normal orientation is reversed and is most commonly associated with situs inversus totalis (SIT). Such cases are technically challenging when heart surgery is needed, especially re-do surgery.
Case Presentation: A 72-year-old female patient was referred to our hospital with complaints of chest tightness and reduced activity tolerance.
J Cardiothorac Surg
January 2025
Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA.
Mitral and aortic annular calcification is an age-related degenerative process that can result in severe mitral and/or aortic stenosis and/or regurgitation. Annular calcification not only increases the surgical complexity but also increases the risk of complications. In this case report, we present the innovative use of the Sonopet ultrasonic surgical aspirator for aortic and mitral annular decalcification in a patient with hypertrophic obstructive cardiomyopathy, mild aortic stenosis and moderate mitral regurgitation in the presence of mitral annular calcification (MAC) and aorto-mitral curtain calcification.
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