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Influence of continuously evolving transcatheter aortic valve implantation technology on cerebral oxygenation

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Abstract

This study assessed the influence of the evolution in Transcatheter Aortic Valve Implantation technology on cerebral oxygenation. Cerebral oxygenation was measured continuously with Near-Infrared Spectroscopy and compared retrospectively between balloon-expandable, self-expandable and differential deployment valves which were implanted in 12 (34%), 17 (49%) and 6 patients (17%), respectively. Left and right SctO2 values were averaged at four time points and used for analysis (i.e. at baseline, balloon-aortic valvuloplasty, valve deployment, and at the end of the procedure). During balloon-aortic valvuloplasty and valve deployment, cerebral oxygenation decreased in patients treated with balloon or self-expandable valves (balloon-expandable: p = 0.003 and p = 0.002; self-expandable: p < 0.001 and p = 0.003, respectively). The incidence of cerebral desaturations below 80% of baseline was significantly larger in patients treated with balloon-expandable valves (p = 0.001). In contrast, patients who received differential deployment valves never experienced a cerebral desaturation below 80% of baseline. Furthermore, both the incidence and duration below a cerebral oxygenation of 55% was significantly different between balloon and self-expandable valves (p = 0.038 and p = 0.018, respectively). This study demonstrated that Transcatheter Aortic Valve Implantation procedures are associated with significant cerebral desaturations, especially during balloon-aortic valvuloplasty and valve deployment. Moreover, our results showed that latest innovations in Transcatheter Aortic Valve Implantation technology beneficially influenced the adequacy of cerebral perfusion.

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Funding

This work was supported by the Limburg Clinical Research Program (LCRP) UHasselt-ZOL- Jessa, supported by the foundation Limburg Sterk Merk, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital.

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Authors and Affiliations

  1. Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg Genk, Schiepse Bos 6, 3600, Genk, Belgium

    Ward Eertmans, Cornelia Genbrugge, Tom Fret, Maud Beran, Kim Engelen, Margot Vander Laenen, Willem Boer, Frank Jans & Cathy De Deyne

  2. Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium

    Ward Eertmans, Cornelia Genbrugge, Frank Jans, Jo Dens & Cathy De Deyne

  3. Department of Cardiac Surgery, Ziekenhuis Oost-Limburg Genk, Schiepse Bos 6, 3600, Genk, Belgium

    Herbert Gutermann

  4. Department of Cardiology, Ziekenhuis Oost-Limburg Genk, Schiepse Bos 6, 3600, Genk, Belgium

    Bert Ferdinande & Jo Dens

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  1. Ward Eertmans
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  2. Cornelia Genbrugge
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  3. Tom Fret
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  6. Herbert Gutermann
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  7. Margot Vander Laenen
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Correspondence to Ward Eertmans.

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Eertmans, W., Genbrugge, C., Fret, T. et al. Influence of continuously evolving transcatheter aortic valve implantation technology on cerebral oxygenation. J Clin Monit Comput 31, 1133–1141 (2017). https://doi.org/10.1007/s10877-016-9971-0

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  • DOI: https://doi.org/10.1007/s10877-016-9971-0

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