Surgical aortic valve replacement resulted in more frequent subsyndromal delirium (54% vs 11%, OR 8.58, p=0.017) and worse 3-month visual recognition memory (mean difference -0.6 vs +0.3, p=0.036) compared to transcatheter aortic valve implantation in patients with low-to-intermediate surgical risk.
RCT (n=31)
Neuropsychologists blinded to randomization status during cognitive assessments
yes
No
Does transcatheter aortic valve implantation improve neurocognitive outcomes compared to surgical aortic valve replacement in patients with severe symptomatic aortic stenosis at low-to-intermediate surgical risk?
In patients with severe aortic stenosis at low-to-intermediate surgical risk, SAVR showed a trend toward less favorable neuropsychological outcomes and higher rates of subsyndromal delirium compared to TAVI.
Effect estimate: OR 0.22 for POCD MOCA at 3 months SAVR vs TAVI; p=0.359 for POCD MOCA (95% CI 0.02-2.13)
Absolute Event Rate: 7.7% vs 27.8%
p-value: p=0.036 for visual recognition memory decline; 0.017 for subsyndromal delirium prevalence difference
Abstract Background Severe symptomatic aortic stenosis is associated with increased morbidity and mortality. Surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) are established treatment options. Neurological complications such as subclinical cerebral ischemia, delirium, and postoperative cognitive decline can occur during either treatment; however, precise data on neurological impairment remain scarce. Objectives The aim of this study was to compare neurological outcomes of patients undergoing TAVI or SAVR. Methods COSTA (Cognitive Outcome after Surgical and Transcatheter Aortic valve replacement) is a single-center sub-study of the randomized DEDICATE trial (clinicaltrials.gov ID: NCT04535076). Neurocognitive tests (memory, attention, language, executive functions), questionnaires on neuropsychology (cognitive failures questionnaire CFQ, hospital anxiety, and depression scale HADS), and health-related quality of life (SF-36) were used before intervention and 3 months thereafter. Cranial magnetic resonance imaging (MRI) was carried out post-intervention. In addition, there was a systematic assessment of delirium during the hospital stay. Results The study cohort (mean age 71.8 years, 32% female) consisted of SAVR ( n = 13) and TAVI ( n = 18) patients. In the SAVR group, subsyndromal delirium was more common (54 vs. 11%, p = 0.017; OR = 8.58), visual recognition ability was worse (mean difference (MD) = − 0.6 vs. + 0.3, p = 0.036, η 2 = 0.14), and emotional impairment was numerically more declined (MD = − 36.8 vs. − 4.7, p = 0.058, η 2 = 0.12) when compared to the TAVI group. Conclusion In this small, exploratory sample, SAVR showed a trend toward less favorable neuropsychological outcomes compared with TAVI in patients with low-to-intermediate surgical risk. Trial registration ClinicalTrials.gov Identifier: NCT04535076. 27 August 2020 (retrospectively registered). Graphical Abstract
Butz et al. (2026) conducted an RCT in Patients with severe symptomatic aortic valve stenosis and low-to-intermediate surgical risk undergoing aortic valve replacement (n=31). Surgical aortic valve replacement (SAVR) vs. Transcatheter aortic valve implantation (TAVI) was evaluated on Postoperative cognitive dysfunction (POCD) and neuropsychological test performance at 3 months (OR 0.22 for POCD MOCA at 3 months SAVR vs TAVI; p=0.359 for POCD MOCA, 95% CI 0.02-2.13, p=0.036 for visual recognition memory decline; 0.017 for subsyndromal delirium prevalence difference). Surgical aortic valve replacement resulted in more frequent subsyndromal delirium (54% vs 11%, OR 8.58, p=0.017) and worse 3-month visual recognition memory (mean difference -0.6 vs +0.3, p=0.036) compared to transcatheter aortic valve implantation in patients with low-to-intermediate surgical risk.
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