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MINERVA ANESTESIOLOGICA

Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2018 March;84(3):328-36

DOI: 10.23736/S0375-9393.17.11905-X

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Patterns of changes in functional and neurocognitive status in elderly patients after transcatheter vs. surgical aortic valve replacements

Marta ZAŁĘSKA-KOCIĘCKA 1 , Anna SKROBISZ 1, Sebastian WOŹNIAK 2, Lidia GRESZATA 1, Maciej DĄBROWSKI 3, Maciej GRABOWSKI 4, Katarzyna PIOTROWSKA 5, Anna KONOPKA 1, Marek BANASZEWSKI 1, Anna MIERZYŃSKA 6, Janina STĘPIŃSKA 1

1 Intensive Cardiac Care Clinic, Institute of Cardiology, Warsaw, Poland; 2 Cardiac Surgery and Transplantology Clinic, Institute of Cardiology, Warsaw, Poland; 3 Interventional Cardiology and Angiology Clinic, Institute of Cardiology, Warsaw, Poland; 4 Acquired Valve Disease Clinic, Institute of Cardiology, Warsaw, Poland; 5 Department of Quantitative Methods and Information Technology, Kozminski University, Warsaw, Poland; 6 Clinic of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, Warsaw, Poland


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BACKGROUND: Replacement of severely stenotic aortic valve may influence cognitive and physical functioning. The aim of this study was to compare cognitive and functional status after surgical (SAVR) vs. transcatheter aortic valve replacements (TAVR) in the elderly with severe aortic stenosis (AS).
METHODS: It was a prospective observational study with over 6 months of follow-up. Eighty ≥70-year-old patients with AS underwent TAVR (N.=40) or SAVR (N.=40). Mini Mental State Exam (MMSE), activities daily living (ADL) score and instrumental activities daily living (IADL) score were used to assess the cognitive status, fundamental functioning and complex independent living skills, respectively. The tests were conducted at baseline and 6 months after the procedure. Additionally, MMSE was carried out at discharge.
RESULTS: Baseline MMSE score was lower in the TAVR vs. SAVR group (P=0.001). In the SAVR group, there was a transient in-hospital decline in mean MMSE score (P=0.020), absent in the TAVR group. Baseline ADL and IADL scores were lower in TAVR patients. Both groups experienced mild improvement. The average increase among those with improved IADL score was larger after TAVR (2.37 vs. 1.37 after SAVR; P=0.029). A systolic blood pressure (SBP) decrease <60 mmHg as well as larger periprocedural shift in SBP (expressed by a difference between maximum and minimum SBP) during TAVR were associated with the decline in the ADL (P=0.001) and IADL scores (P=0.043).
CONCLUSIONS: Cognitive patterns differed between the TAVR and SAVR patients. A transient MMSE decline did not alter the 6-month status. TAVR might improve functionality. Periprocedural SBP decrease and larger changes in SBP are risk factors for functionality deterioration after TAVR.


KEY WORDS: Aortic valve stenosis - Transcatheter aortic valve replacement - Activities of daily living - Cognition - Quality of life - Cognitive dysfunction

inizio pagina

Publication History

Issue published online: April 3, 2018
Article first published online: October 4, 2017
Manuscript accepted: September 15, 2017
Manuscript revised: September 6, 2017
Manuscript received: January 2, 2017

Per citare questo articolo

Załęska-Kocięcka M, Skrobisz A, Woźniak S, Greszata L, Dąbrowski M, Grabowski M, et al. Patterns of changes in functional and neurocognitive status in elderly patients after transcatheter vs. surgical aortic valve replacements. Minerva Anestesiol 2018;84:328-36. DOI: 10.23736/S0375-9393.17.11905-X

Corresponding author e-mail

mzaleska@ikard.pl