Superior Cognitive Benefits With TAVR vs SAVR

Batya Swift Yasgur MA, LSW

November 23, 2020

Patients with cognitive impairment may experience greater improvements in cognition with transcatheter aortic valve replacement (TAVR) than with surgical aortic valve replacement (SAVR), new research suggests.

Investigators analyzed data from the PARTNER 3 (Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low-Risk Patients with Aortic Stenosis) trial of 1000 patients with severe aortic stenosis, who were randomized to receive either TAVR or SAVR.

They found that patients with lower cognition who underwent TAVR experienced greater cognitive improvements 30 days and 1 year after the procedure than those who underwent SAVR. However, patients with normal cognition at baseline improved only in the first 30 days but showed no further improvements at 1 year.

"Our study and other smaller studies suggest that there could be improvement in neurocognitive function after TAVR in some patients with abnormal baseline cognition," lead author Srinvasa Potluri, MD, Cardiac Catheterization Laboratory, Baylor Scott and White Legacy Heart Center, Plano, Texas, told theheart.org | Medscape Cardiology.

Patients with lower Mini-Mental Status Exam (MMSE) scores at baseline, "could be considered for TAVR after heart-team discussion weighing benefits and risks," he said.

The study was published online November 16 in JACC Interventional Cardiology.

Low-risk Patients

Previous studies have suggested a greater decline in cognitive function among high-risk patients with aortic stenosis after being treated with SAVR, compared with TAVR, as indicated by a greater drop in MMSE scores, the authors write.

In intermediate-risk patients, no differences in postprocedure cognitive decline were found between TAVR and SAVR, although "TAVR was associated with global improvement in cognitive status," they write, noting that the improvement was "more pronounced" in patients with cognitive impairment prior to TAVR.

Findings indicating cognitive improvements after TAVR in high- and intermediate-risk groups inspired the current analysis of change in neurocognitive function in low-risk patients randomized to TAVR or SAVR, Potluri said.

To investigate the question, the researchers analyzed data from the PARTNER 3 trial, in which patients with severe aortic stenosis underwent either TAVR with a balloon-expandable valve or SAVR.

Patients completed neurocognitive testing at baseline, 30 days, and 1 year, with a baseline mean (±SD) MMSE score of 26.6 (±2.49) in all patients. Patients with lower cognition (17.8%) had a baseline MMSE score of 27 or lower.

Significant Improvement

In patients overall, there was "some minimal improvement" in MMSE from baseline to 30 days, but no improvement at 1 year. In contrast, patients with an MMSE score of 27 or below showed "significant" improvement in scores of cognition.

Mean (± Standard Deviation) Changes From Baseline
Baseline
MMSE
Score
Overall Population TAVR SAVR
30-day visit
All scores n = 876
0.1 ± 2.92
n = 477
0.3 ± 3.33
n = 399
−0.1 ± 2.64
≤27 n = 150
2.4 ± 4.34
n = 86
2.4 ± 4.60
n = 64
2.3 ± 4.00
1-year visit
All scores n = 815
0.2 ± 2.60
n = 455
0.3 ± 2.83
n = 360
0.0 ± 2.26
≤27 n = 144
2.2 ± 4.75
n = 83
2.7 ± 5.04
n = 61
1.5 ± 4.27

It's not clear why patients in the TAVR group improved more than those in the SAVR group, Potluri said. "However, there is no pump run in TAVR patients and subclinical stroke may be lower in TAVR as well," he noted.

"Reassuring" Findings

Commenting on the study for theheart.org | Medscape Cardiology, Josep Rodés-Cabau, MD, Quebec Heart and Lung Institute, Laval University, Quebec City, called it "interesting and reassuring," noting that his group published similar findings regarding changes in cognitive functioning in high-risk TAVR patients.

"This paper provides further reassurance that cognitive function doesn't seem to change after TAVR," said Rodés-Cabau, who was not involved with the study.

He noted that a procedure like TAVR "improves the hemodynamics of the patient," and in critical aortic stenosis, blood flow to the brain is "probably not perfect," so when the aortic stenosis is relieved, cognition can improve.

"To me, I take a global picture, which is that cognitive function does not deteriorate after TAVR in low-risk patients, which is very good news," said Rodés-Cabau.

Potluri added that their findings are "hypothesis-generating and need to be confirmed in larger studies."

His group plans to continue collecting neurocognitive information in patients who undergo TAVR. "The current study we published is a 1-year follow-up and these patients will continue to be followed," he said.

This work was funded by Edwards Lifesciences. Potluri has received honoraria from Boston Scientific, Medtronic, Edwards Lifesciences, Zoll, Gore, Abbott, and Cardinal. The other authors' disclosures are listed in the publication. Rodés-Cabau has received institutional research grants from Edwards Lifesciences and Medtronic, but reports no financial relationships relevant to his comments on this study.

J Am Coll Cardiol Cardiovasc Interv. Published online November 16, 2020. Abstract

For more theheart.org | Medscape Cardiology news, join us on Facebook and Twitter.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....