Clinical and neurocognitive outcomes in patients with supra-arch vascular disease following transcatheter aortic valve replacement

Abstract Background Symptomatic carotid, vertebral and subclavian artery stenosis are associated with the risk of stroke, but the impact of these supra-arch vascular diseases (SAVD) on clinical and neurocognitive outcomes following transcatheter aortic valve replacement (TAVR) is unclear. Methods Preoperative carotid/vertebral duplex ultrasonography and computed tomography were performed to identify the presence of SAVD. Prospective neurological assessments (Barthel Index), global cognitive tests (Mini-Mental State Examination, MMSE) and executive performances (Color Trail Test A and B and verbal fluency), were applied at baseline, 3 months and 1 year post-TAVR. Results Overall, a total of 210 patients were evaluated, and 59 patients (28.1%) had SAVD (carotid stenosis: 37, vertebral stenosis: 23, subclavian stenosis: 6). The patients with SAVD were older (84.0±5.7 vs 79.4±8.2, P=0.0001) and had higher incidence of prior stroke or transient ischemic accident (15.3% vs 5.9%, P=0.031). There was no association between the presence of SAVD and stroke (adjusted hazard ratio (aHR): 1.26; 95% confidence interval (95% CI): 0.217-7.341) or mortality (aHR, 1.38; 95% CI:0.834-2.813). After propensity score matching in patients complete neurocognitive assessment after TAVR, the baseline neurocognitive performance were similar between the patients with (N=44) and without SAVD (N=74). Persistent improvement up to 1 year in Barthel Index, MMSE, Color Trail Test A and B could be observed only in the patients without SAVD, but not in patients with SAVD. Conclusions The presence of SAVD was not associated with an increased risk of post-TAVR stroke or mortality. However, the persistent improvement in neurocognitive assessments after TAVR could only be seen in patients without SAVD.