TY  - JOUR
A1  - Seppelt, Philipp
A1  - Mas-Peiro, Silvia
A1  - De Rosa, Roberta
A1  - Murray, Isabell M.
A1  - Arsalan, Mani
A1  - Holzer, Lars
A1  - Lotz, Gösta
A1  - Meybohm, Patrick
A1  - Zacharowski, Kai
A1  - Walther, Thomas
A1  - Zeiher, Andreas M.
A1  - Fichtlscherer, Stephan
A1  - Vasa-Nicotera, Mariuca
T1  - Dynamics of cerebral oxygenation during rapid ventricular pacing and its impact on outcome in transfemoral transcatheter aortic valve implantation
T2  - Catheterization and cardiovascular interventions
N2  - Background: Cerebral O2 saturation (ScO2) reflects cerebral perfusion and can be measured noninvasively by near-infrared spectroscopy (NIRS). Objectives: In this pilot study, we describe the dynamics of ScO2 during TAVI in nonventilated patients and its impact on procedural outcome. Methods and Results: We measured ScO2 of both frontal lobes continuously by NIRS in 50 consecutive analgo-sedated patients undergoing transfemoral TAVI (female 58%, mean age 80.8 years). Compared to baseline ScO2 dropped significantly during RVP (59.3% vs. 53.9%, p < .01). Five minutes after RVP ScO2 values normalized (post RVP 62.6% vs. 53.9% during RVP, p < .01; pre 61.6% vs. post RVP 62.6%, p = .53). Patients with an intraprocedural pathological ScO2 decline of >20% (n = 13) had higher EuroSCORE II (3.42% vs. 5.7%, p = .020) and experienced more often delirium (24% vs. 62%, p = .015) and stroke (0% vs. 23%, p < .01) after TAVI. Multivariable logistic regression revealed higher age and large ScO2 drops as independent risk factors for delirium. Conclusions: During RVP ScO2 significantly declined compared to baseline. A ScO2 decline of >20% is associated with a higher incidence of delirium and stroke and a valid cut-off value to screen for these complications. NIRS measurement during TAVI procedure may be an easy to implement diagnostic tool to detect patients at high risks for cerebrovascular complications and delirium.
KW  - aortic stenosis
KW  - delirium
KW  - NIRS
KW  - stroke
KW  - TAVI
Y1  - 2020
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/63840
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-638402
SN  - 1522-726X
VL  - 97
IS  - 1
SP  - E146
EP  - E153
PB  - Wiley Interscience
CY  - New York, NY
ER  -