Transcranial Doppler-Guided Resuscitation during Transcatheter Aortic Valve Replacement

Khai Doan Nang 1 , Michael Reardon 1 , Alan Lumsden 1 , and Zsolt Garami 1
  • 1 Department of Cardiovascular Surgery, Houston Methodist Hospital, , Houston

Abstract

Introduction: Transcatheter aortic valve replacement (TAVR) has become an optimal substitute treatment for subjects with severe aortic stenosis who cannot undergo open chest surgery or who have a high surgical risk. Transcranial Doppler (TCD) provides monitoring of microembolic signals and cerebral blood flow during TAVR and detects ongoing fluctuations of intracerebral hemodynamics during each phase of the procedure.

Case report: We present the case of a patient who underwent TAVR, during which bilateral monitoring of the middle cerebral artery blood flow was performed with TCD.

Conclusions: The effectiveness of transcranial Doppler to identify cerebral embolisms and variations in the cerebral hemodynamics is imperative in fending off complications during transcatheter aortic valve replacement.

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  • 1. Deeb GM, Reardon MJ, Chetcuti S, et al. 3-Year Outcomes in High-Risk Patients Who Underwent Surgical or Transcatheter Aortic Valve Replacement. J Am Coll Cardiol. 2016;67:2565-2574. doi: 10.1016/j.jacc.2016.03.506.

  • 2. Svensson LG. Transcatheter Aortic Valve Replacement in Moderate-risk Aortic Stenosis Patients. Interventional Cardiology Review. 2014;9:41-43. doi: http://dx.doi.org/10.15420/icr.2011.9.1.41.

  • 3. Reinöhl J, Kaier K, Reinecke H, et al. Effect of Availability of Transcatheter Aortic-Valve Replacement on Clinical Practice. N Engl J Med. 2015;373:2438-2447. doi: 10.1056/NEJMoa1500893.

  • 4. Aaslid R, Markwalder TM, Nornes H. Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg. 1982;57:769-774. doi: 10.3171/jns.1982.57.6.0769.

  • 5. Ringelstein EB, Droste DW, Babikian VL, et al. Consensus on microembolus detection by TCD. International Consensus Group on Microembolus Detection. Stroke. 1998;29:725-729.

  • 6. Camerlingo M, Casto L, Censori B, Ferraro B, Gazzaniga GC, Mamoli A. Transcranial Doppler in acute ischemic stroke of the middle cerebral artery territories. Acta Neurol Scand. 1993;88:108-111.

  • 7. Roselli EE, Idrees J, Mick S, et al. Emergency use of cardiopulmonary bypass in complicated transcatheter aortic valve replacement: Importance of a heart team approach. J Thorac Cardiovasc Surg. 2014;148:1413-1416. doi: 10.1016/j.jtcvs.2013.12.052.

  • 8. Kleiman N. Room Considerations with TAVR. Methodist Debakey Cardiovasc J. 2012;8:19-21.

  • 9. Hecker F, Arsalan M, Walther T, et al. Managing stroke during transcatheter aortic valve replacement. Interventional Cardiology Review. 2017;12:25-30. doi: .15420/icr.2016:26:1.

  • 10. Kahlert P, Al-Rashid F, Döttger P, et al. Cerebral Embolization During Transcatheter Aortic Valve Implantation. Circulation. 2012;126:1245-1255. doi: 10.1161/CIRCULATIONAHA.112.092544.

  • 11. Szeto WY, Augoustides JG, Desai ND, et al. Cerebral embolic exposure during transfemoral and transapical transcatheter aortic valve replacement. J Card Surg. 2011;26:348-354. doi: 10.1111/j.1540-8191.2011.01265.x.

  • 12. Schmidt T, Akdag O, Wohlmuth P, et al. Histological Findings and Predictors of Cerebral Debris From Transcatheter Aortic Valve Replacement: The ALSTER Experience. J Am Heart Assoc. 2016;5:e004399. doi: 10.1161/JAHA.116.004399.

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