Tần suất, yếu tố dự đoán, nguồn gốc và phòng ngừa các sự kiện thần kinh sớm và muộn sau khi cấy ghép van động mạch chủ qua ống thông (TAVI): một cái nhìn toàn diện về dữ liệu hiện tại

Philipp Kahlert1, Fadi Al-Rashid1, Björn Plicht1, Heike Hildebrandt1, Polykarpos Patsalis1, Karim El Chilali1, Daniel Wendt2, Matthias Thielmann2, Lars Bergmann3, Eva Kottenberg3, Marc Schlamann4, Holger Eggebrecht1,5, Heinz Jakob2, Gerd Heusch6, Thomas Konorza1, Raimund Erbel1
1Department of Cardiology, West-German Heart Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany
2Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany
3Clinic for Anaesthesiology and Intensive Care Medicine, Essen University Hospital, University Duisburg-Essen, Essen, Germany
4Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, University Duisburg-Essen, Essen, Germany
5Cardioangiological Center Bethanien, Frankfurt, Germany
6Institute for Pathophysiology, Essen University Hospital, University Duisburg-Essen, Essen, Germany

Tóm tắt

Cấy ghép van động mạch chủ qua ống thông (TAVI) là một lựa chọn điều trị mới cho những bệnh nhân bị hẹp van động mạch chủ nghiêm trọng, có triệu chứng và được coi là không thể phẫu thuật hoặc có nguy cơ cao trong việc thay thế van động mạch chủ bằng phẫu thuật. Mặc dù công nghệ này đã được áp dụng nhanh chóng vào liệu pháp lâm sàng, nhưng gần đây, các nghiên cứu thử nghiệm lâm sàng ngẫu nhiên có đối chứng đã dấy lên mối lo ngại về sự an toàn liên quan đến tăng nguy cơ các sự kiện thần kinh khi so sánh TAVI với cả điều trị y tế và thay thế van động mạch chủ bằng phẫu thuật thông thường. Hơn nữa, các nghiên cứu hình ảnh thần kinh đã tiết lộ tần suất xuất hiện thậm chí còn cao hơn của các tổn thương não mới, mặc dù lâm sàng không đáng kể, như một dấu hiệu thay thế cho quá trình thuyên tắc trong quá trình thủ thuật. Trong bài viết này, chúng tôi xem xét dữ liệu hiện có về tần suất, thời gian, các yếu tố dự đoán, ý nghĩa tiên đoán và các cơ chế tiềm tàng của các sự kiện thần kinh sau TAVI.

Từ khóa

#TAVI #van động mạch chủ #sự kiện thần kinh #thuyên tắc #hẹp van động mạch chủ

Tài liệu tham khảo

Daneault B, Kirtane AJ, Kodali SK, Williams MR, Genereux P, Reiss GR, Smith CR, Moses JW, Leon MB (2011) Stroke associated with surgical and transcatheter treatment of aortic stenosis: a comprehensive review. J Am Coll Cardiol 58:2143–2150

O’Brien SM, Shahian DM, Filardo G, Ferraris VA, Haan CK, Rich JB, Normand SL, DeLong ER, Shewan CM, Dokholyan RS, Peterson ED, Edwards FH, Anderson RP (2009) The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2–isolated valve surgery. Ann Thorac Surg 88:S23–S42

Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Brown DL, Block PC, Guyton RA, Pichard AD, Bavaria JE, Herrmann HC, Douglas PS, Petersen JL, Akin JJ, Anderson WN, Wang D, Pocock S (2010) Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363:1597–1607

Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Williams M, Dewey T, Kapadia S, Babaliaros V, Thourani VH, Corso P, Pichard AD, Bavaria JE, Herrmann HC, Akin JJ, Anderson WN, Wang D, Pocock SJ (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364:2187–2198

Kahlert P, Knipp SC, Schlamann M, Thielmann M, Al-Rashid F, Weber M, Johansson U, Wendt D, Jakob HG, Forsting M, Sack S, Erbel R, Eggebrecht H (2010) Silent and apparent cerebral ischemia after percutaneous transfemoral aortic valve implantation: a diffusion-weighted magnetic resonance imaging study. Circulation 121:870–878

Ghanem A, Muller A, Nahle CP, Kocurek J, Werner N, Hammerstingl C, Schild HH, Schwab JO, Mellert F, Fimmers R, Nickenig G, Thomas D (2010) Risk and fate of cerebral embolism after transfemoral aortic valve implantation: a prospective pilot study with diffusion-weighted magnetic resonance imaging. J Am Coll Cardiol 55:1427–1432

Arnold M, Schulz-Heise S, Achenbach S, Ott S, Dorfler A, Ropers D, Feyrer R, Einhaus F, Loders S, Mahmoud F, Roerick O, Daniel WG, Weyand M, Ensminger SM, Ludwig J (2010) Embolic cerebral insults after transapical aortic valve implantation detected by magnetic resonance imaging. JACC Cardiovasc Interv 3:1126–1132

Rodes-Cabau J, Dumont E, Boone RH, Larose E, Bagur R, Gurvitch R, Bedard F, Doyle D, De Larochelliere R, Jayasuria C, Villeneuve J, Marrero A, Cote M, Pibarot P, Webb JG (2011) Cerebral embolism following transcatheter aortic valve implantation: comparison of transfemoral and transapical approaches. J Am Coll Cardiol 57:18–28

Astarci P, Glineur D, Kefer J, D’Hoore W, Renkin J, Vanoverschelde JL, El Khoury G, Grandin C (2011) Magnetic resonance imaging evaluation of cerebral embolization during percutaneous aortic valve implantation: comparison of transfemoral and trans-apical approaches using Edwards Sapiens valve. Eur J Cardiothorac Surg 40:475–479

Fairbairn TA, Mather AN, Bijsterveld P, Worthy G, Currie S, Goddard AJ, Blackman DJ, Plein S, Greenwood JP (2012) Diffusion-weighted MRI determined cerebral embolic infarction following transcatheter aortic valve implantation: assessment of predictive risk factors and the relationship to subsequent health status. Heart 98:18–23

Leon MB, Piazza N, Nikolsky E, Blackstone EH, Cutlip DE, Kappetein AP, Krucoff MW, Mack M, Mehran R, Miller C, Morel MA, Petersen J, Popma JJ, Takkenberg JJ, Vahanian A, van Es GA, Vranckx P, Webb JG, Windecker S, Serruys PW (2011) Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the valve academic research consortium. J Am Coll Cardiol 57:253–269

van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607

Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR, Fontana GP, Dewey TM, Thourani VH, Pichard AD, Fischbein M, Szeto WY, Lim S, Greason KL, Teirstein PS, Malaisrie SC, Douglas PS, Hahn RT, Whisenant B, Zajarias A, Wang D, Akin JJ, Anderson WN, Leon MB (2012) Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 366:1686–1695

Makkar RR, Fontana GP, Jilaihawi H, Kapadia S, Pichard AD, Douglas PS, Thourani VH, Babaliaros VC, Webb JG, Herrmann HC, Bavaria JE, Kodali S, Brown DL, Bowers B, Dewey TM, Svensson LG, Tuzcu M, Moses JW, Williams MR, Siegel RJ, Akin JJ, Anderson WN, Pocock S, Smith CR, Leon MB (2012) Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med 366:1696–1704

Eggebrecht H, Schmermund A, Voigtlander T, Kahlert P, Erbel R, Mehta RH (2012) Risk of stroke after transcatheter aortic valve implantation (TAVI): a meta-analysis of 10,037 published patients. EuroIntervention 8:129–138

Grube E, Buellesfeld L, Mueller R, Sauren B, Zickmann B, Nair D, Beucher H, Felderhoff T, Iversen S, Gerckens U (2008) Progress and current status of percutaneous aortic valve replacement: results of three device generations of the CoreValve Revalving system. Circ Cardiovasc Interv 1:167–175

Gilard M, Eltchaninoff H, Iung B, Donzeau-Gouge P, Chevreul K, Fajadet J, Leprince P, Leguerrier A, Lievre M, Prat A, Teiger E, Lefevre T, Himbert D, Tchetche D, Carrie D, Albat B, Cribier A, Rioufol G, Sudre A, Blanchard D, Collet F, Dos Santos P, Meneveau N, Tirouvanziam A, Caussin C, Guyon P, Boschat J, Le Breton H, Collart F, Houel R, Delpine S, Souteyrand G, Favereau X, Ohlmann P, Doisy V, Grollier G, Gommeaux A, Claudel JP, Bourlon F, Bertrand B, Van Belle E, Laskar M (2012) Registry of transcatheter aortic-valve implantation in high-risk patients. N Engl J Med 366:1705–1715

Adams HPJ (2010) Ischemic cerebrovascular complications of cardiac procedures. Circulation 121:846–847

Bendszus M, Stoll G (2006) Silent cerebral ischaemia: hidden fingerprints of invasive medical procedures. Lancet Neurol 5:364–372

Omran H, Schmidt H, Hackenbroch M, Illien S, Bernhardt P, von der Recke G, Fimmers R, Flacke S, Layer G, Pohl C, Luderitz B, Schild H, Sommer T (2003) Silent and apparent cerebral embolism after retrograde catheterisation of the aortic valve in valvular stenosis: a prospective, randomised study. Lancet 361:1241–1246

Brott T, Adams HPJ, Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J, Holleran R, Eberle R, Hertzberg V et al (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20:864–870

Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

Miller DC, Blackstone EH, Mack MJ, Svensson LG, Kodali SK, Kapadia S, Rajeswaran J, Anderson WN, Moses JW, Tuzcu EM, Webb JG, Leon MB, Smith CR (2012) Transcatheter (TAVR) versus surgical (AVR) aortic valve replacement: occurrence, hazard, risk factors, and consequences of neurologic events in the PARTNER trial. J Thorac Cardiovasc Surg 143(832–843):e13

Tay EL, Gurvitch R, Wijesinghe N, Nietlispach F, Wood D, Cheung A, Ye J, Lichtenstein SV, Carere R, Thompson C, Webb JG (2011) A high-risk period for cerebrovascular events exists after transcatheter aortic valve implantation. JACC Cardiovasc Interv 4:1290–1297

Stortecky S, Windecker S, Pilgrim T, Heg D, Buellesfeld L, Khattab AA, Huber C, Gloekler S, Nietlispach F, Mattle H, Juni P, Wenaweser P (2012) Cerebrovascular accidents complicating transcatheter aortic valve implantation: frequency, timing and impact on outcomes. EuroIntervention 8:62–70

Nuis RJ, Van Mieghem NM, Schultz CJ, Moelker A, van der Boon RM, van Geuns RJ, van der Lugt A, Serruys PW, Rodes-Cabau J, van Domburg RT, Koudstaal PJ, de Jaegere PP (2012) Frequency and causes of stroke during or after transcatheter aortic valve implantation. Am J Cardiol 109:1637–1643

Nombela-Franco L, Webb JG, de Jaegere P, Toggweiler S, Nuis RJ, Dager AE, Amat-Santos IJ, Cheung A, Ye J, Binder RK, van der Boon RM, Van Mieghem N, Benitez LM, Perez S, Lopez J, San Roman JA, Doyle D, Delarochelliere R, Urena M, Leipsic J, Dumont E, Rodes-Cabau J (2012) Timing, predictive factors and prognostic value of cerebrovascular events in a large cohort of patients undergoing transcatheter aortic valve implantation. Circulation 126(25):3041–3053

Melby SJ, Zierer A, Kaiser SP, Guthrie TJ, Keune JD, Schuessler RB, Pasque MK, Lawton JS, Moazami N, Moon MR, Damiano RJJ (2007) Aortic valve replacement in octogenarians: risk factors for early and late mortality. Ann Thorac Surg 83:1651–1656; discussion 1656–7

Tamburino C, Capodanno D, Ramondo A, Petronio AS, Ettori F, Santoro G, Klugmann S, Bedogni F, Maisano F, Marzocchi A, Poli A, Antoniucci D, Napodano M, De Carlo M, Fiorina C, Ussia GP (2011) Incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis. Circulation 123:299–308

Kahlert P, Doettger P, Mori K, Al-Rashid F, Thielmann M, Wendt D, Schlamann M, Jakob HG, Erbel R, Eggebrecht, H (2012) Cerebral embolization during transcatheter aortic valve implantation (TAVI): a transcranial Doppler study. Circulation 126(10):1245–1255

Schaff HV (2011) Transcatheter aortic-valve implantation—at what price? N Engl J Med 364:2256–2258

Sack S, Kahlert P, Khandanpour S, Naber C, Philipp S, Mohlenkamp S, Sievers B, Kalsch H, Erbel R (2008) Revival of an old method with new techniques: balloon aortic valvuloplasty of the calcified aortic stenosis in the elderly. Clin Res Cardiol 97:288–297

Ben-Dor I, Pichard AD, Satler LF, Goldstein SA, Syed AI, Gaglia MAJ, Weissman G, Maluenda G, Gonzalez MA, Wakabayashi K, Collins SD, Torguson R, Okubagzi P, Xue Z, Kent KM, Lindsay J, Waksman R (2010) Complications and outcome of balloon aortic valvuloplasty in high-risk or inoperable patients. JACC Cardiovasc Interv 3:1150–1156

Erdoes G, Basciani R, Huber C, Stortecky S, Wenaweser P, Windecker S, Carrel T, Eberle B (2012) Transcranial Doppler-detected cerebral embolic load during transcatheter aortic valve implantation. Eur J Cardiothorac Surg 41:778–783; discussion 783–4

Szeto WY, Augoustides JG, Desai ND, Moeller P, McGarvey ML, Walsh E, Bannan A, Herrmann HC, Bavaria JE (2011) Cerebral embolic exposure during transfemoral and transapical transcatheter aortic valve replacement. J Card Surg 26:348–354

Drews T, Pasic M, Buz S, Unbehaun A, Dreysse S, Kukucka M, Mladenow A, Hetzer R (2011) Transcranial Doppler sound detection of cerebral microembolism during transapical aortic valve implantation. Thorac Cardiovasc Surg 59:237–242

van der Linden J, Casimir-Ahn H (1991) When do cerebral emboli appear during open heart operations? A transcranial Doppler study. Ann Thorac Surg 51:237–241

Noble S, Asgar A, Cartier R, Virmani R, Bonan R (2009) Anatomo-pathological analysis after CoreValve Revalving system implantation. EuroIntervention 5:78–85

Al-Rashid F, Konorza TF, Plicht B, Wendt D, Thielmann M, Jakob H, Erbel R, Kahlert P (2012) Transient increase in pressure gradients after termination of dual antiplatelet therapy in a patient after transfemoral aortic valve implantation. Circ Cardiovasc Interv 5:318–320

Amat-Santos IJ, Rodes-Cabau J, Urena M, DeLarochelliere R, Doyle D, Bagur R, Villeneuve J, Cote M, Nombela-Franco L, Philippon F, Pibarot P, Dumont E (2012) Incidence, predictive factors, and prognostic value of new-onset atrial fibrillation following transcatheter aortic valve implantation. J Am Coll Cardiol 59:178–188

Hynes BG, Rodes-Cabau J (2012) Transcatheter aortic valve implantation and cerebrovascular events: the current state of the art. Ann N Y Acad Sci 1254:151–163

Naber CK, Ghanem A, Abizaid AA, Wolf A, Sinning JM, Werner N, Nickenig G, Schmitz T, Grube E (2012) First-in-man use of a novel embolic protection device for patients undergoing transcatheter aortic valve implantation. EuroIntervention 8:43–50

Nietlispach F, Wijesinghe N, Gurvitch R, Tay E, Carpenter JP, Burns C, Wood DA, Webb JG (2010) An embolic deflection device for aortic valve interventions. JACC Cardiovasc Interv 3:1133–1138

Onsea K, Agostoni P, Samim M, Voskuil M, Kluin J, Budde R, Hendrikse J, Ramjankhan F, van Klarenbosch J, Doesburg P, Sieswerda G, Stella P (2012) First-in-man experience with a new embolic deflection device in transcatheter aortic valve interventions. EuroIntervention 8:51–56

Grube E, Naber C, Abizaid A, Sousa E, Mendiz O, Lemos P, Kalil Filho R, Mangione J, Buellesfeld L (2011) Feasibility of transcatheter aortic valve implantation without balloon pre-dilation: a pilot study. JACC Cardiovasc Interv 4:751–757

Dangas G (2011) Efficacy and safety of bivalirudin compared to unfractionated heparin among patients undergoing balloon aortic valvuloplasty: a two-center registry. J Am Coll Cardiol 58:B127