Cognitive function assessment in patients undergoing transcatheter aortic valve implantation

Aortic stenosis is the most commonly acquired valvular heart disease in developed countries. Although surgical aortic valve replacement remains the gold standard of treatment, in a number of patients with high perioperative risk, transcatheter aortic valve implantation (TAVI) is the preferred method. Embolic events involving the central nervous system may cause complications in TAVI and may worsen its results. Tests performed using DW-MRI suggest that TAVI, like other cardiac and cardiac surgery procedures, is fraught with increased risk of microemboli. The impairment of the vascular flow to brain tissue may lead to damage of brain structures, which in turn might result in brain disorders. Aware of these risks in patients requiring aortic valve implantation, medical personnel performing such procedures are impelled to monitor the severity of brain impairment, whereas the steady technological progress in the field of methods and systems of this endovascular procedure aims at reducing the number of complications, including the protection of the central nervous system. An important, albeit poorly understood, issue is the assessment of the cognitive function in both the perioperative and postoperative period in patients undergoing the TAVI procedure. This paper highlights two aspects - the deterioration of cognitive functions due to perioperative impairment of blood supply to the central nervous system and their potential augmentation resulting from postoperative hemodynamic improvement. Nevertheless, the influence of TAVI on cognitive disorders remains unclear and requires further research.