Featured Research

from universities, journals, and other organizations

Gentler heart surgery remains without signs of dementia

Date:
December 5, 2013
Source:
Universität Bonn
Summary:
Aortic valve stenosis is the most frequent heart valve defect of older people in Europe. In patients at high and excessive risk, conventional cardiac surgery is often no therapeutic option, leaving only transcatheter aortic valve implantation (TAVI) as an option. However, this procedure has major side effects. A long-term study shows that clinicians are able to exclude significant cognitive impairment for the majority of patients undergoing TAVI.

Fit three years after surgery: Patient Gerhard E. (l.) speaking with Privatdozent Dr. Alexander Ghanem.
Credit: © Rolf Müller / Bonn University Medical Center (UKB)

Aortic valve stenosis is the most frequent heart valve defect of older people in Europe -- the cause is usually increasing calcification of this important valve. In patients at high and excessive risk, conventional cardiac surgery is often no therapeutic option. For these patients, transcatheter aortic valve implantation (TAVI) remains the only opportunity. However, this procedure often leads to a crumbling and spreading of valvular calcium deposits and consecutive occlusion of smallest blood vessels of the brain. Conceivably, this so called "microembolisation," could lead to impairment of mental performance. In a long-term study, cardiologists at the Heart Center of the Bonn University Medical Center were able to exclude significant cognitive impairment for the majority of patients undergoing TAVI.

Gerhard E. could not breathe right. His aortic valve was relevantly narrowed and hardly opened anymore. For the 83-year-old, who had already had prior cardiac surgery, the "state-of-the-art" surgical valve replacement utilizing extracorporal circulation was too risky. But without replacement of the valve, his prognosis would have been very poor. Consequently, Prof. Dr. Georg Nickenig, Chair of the Department of Cardiology of the Bonn University Medical Center, who weighed the risks and benefits together with Prof. Dr. Armin Welz, Chair of the Department of Cardiac Surgery, recommended transcatheter aortic valve implantation (TAVI) to Gerhard E. three years ago. "I was really happy and relieved that there was a second, gentler alternative for my father," his son says.

"However, even this technologically mature intervention, which requires a sophisticated apparatus, is associated with some risks" Prof. Nickenig knows. Small particles of valvular calcium deposits can be mobilized during the procedure and spread to the brain with the bloodstream. Hence, interventional and surgical replacement of severely calcified heart valves are associated with a stroke risk of approximately 2-5%.

"Mini-strokes" a risk to memory?

In contrast, the cognitive performance level, such as intellectual function, memory, orientation, and concentration of the patients, had not yet been studied over the long term following implantation of an aortic valve. "However, this is of great importance in the ability of our elderly patients to cope with everyday life and to retain their independence, in particular considering the rising life expectancy"; that is how Privatdozent Dr. Alexander Ghanem, Senior Physician at the Department of Medicine II of the Bonn University Medical Center describes his motivation to conduct such a study. With this in mind, he prospectively investigated 125 high-risk patients -- including Gerhard E. He recently published the results in the well-known technical journal "Circulation: Cardiovascular Interventions."

In cooperation with the Department of Radiology of the Bonn University Medical Center, using MRI exams of the brain following aortic valve implantation, he very frequently observed "microembolism" in the patients' brains -- as a result of spreaded calcium deposits from the heart valve that were transported into the brain. The question arises whether clinically silent "microembolism" could be associated with the later occurrence of dementia spectrum disorders. Thus, in collaboration with the German Center for Neurodegenerative Diseases (DZNE) in Bonn, Ghanem tested and compared the cognitive capacity and memory capacity of patients before and after the intervention: "More than 90 percent remained consistently unharmed in this respect throughout two years after valve implantation."

Microembolic events had no influence on mental performance

On the other hand, elderly patients with aortic valve stenosis often have restricted cognitive capacity prior TAVI -- possibly due to a narrowed aortic valve, leading, among other things, to inadequate blood supply in the brain. "Happily, even patients markedly below average cognitive performance prior the intervention had no significant decay of cognitive and mental performance levels for up to two years after the intervention. Consequently, the mental capacity even of these patients is not negatively impaired by aortic valve implantation," says Ghanem.

And also not for Gerhard E., who is still delighted with the intervention three years ago: "My son and I often go for a walk. The exercise is good for me," says the 83-year-old.


Story Source:

The above story is based on materials provided by Universität Bonn. Note: Materials may be edited for content and length.


Journal Reference:

  1. A. Ghanem, J. Kocurek, J.-M. Sinning, M. Wagner, B. V. Becker, M. Vogel, T. Schroder, S. Wolfsgruber, M. Vasa-Nicotera, C. Hammerstingl, J. O. Schwab, D. Thomas, N. Werner, E. Grube, G. Nickenig, A. Muller. Cognitive Trajectory After Transcatheter Aortic Valve Implantation. Circulation: Cardiovascular Interventions, 2013; DOI: 10.1161/CIRCINTERVENTIONS.112.000429

Cite This Page:

Universität Bonn. "Gentler heart surgery remains without signs of dementia." ScienceDaily. ScienceDaily, 5 December 2013. <www.sciencedaily.com/releases/2013/12/131205092723.htm>.
Universität Bonn. (2013, December 5). Gentler heart surgery remains without signs of dementia. ScienceDaily. Retrieved July 30, 2014 from www.sciencedaily.com/releases/2013/12/131205092723.htm
Universität Bonn. "Gentler heart surgery remains without signs of dementia." ScienceDaily. www.sciencedaily.com/releases/2013/12/131205092723.htm (accessed July 30, 2014).

Share This




More Mind & Brain News

Wednesday, July 30, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

It's Not Just Facebook: OKCupid Experiments With Users Too

It's Not Just Facebook: OKCupid Experiments With Users Too

Newsy (July 29, 2014) — If you've been looking for love online, there's a chance somebody has been looking at how you're looking. Video provided by Newsy
Powered by NewsLook.com
How Your Face Can Leave A Good Or Bad First Impression

How Your Face Can Leave A Good Or Bad First Impression

Newsy (July 29, 2014) — Researchers have found certain facial features can make us seem more attractive or trustworthy. Video provided by Newsy
Powered by NewsLook.com
Losing Sleep Leaves You Vulnerable To 'False Memories'

Losing Sleep Leaves You Vulnerable To 'False Memories'

Newsy (July 27, 2014) — A new study shows sleep deprivation can make it harder for people to remember specific details of an event. Video provided by Newsy
Powered by NewsLook.com
University Quiz Implies Atheists Are Smarter Than Christians

University Quiz Implies Atheists Are Smarter Than Christians

Newsy (July 25, 2014) — An online quiz from a required course at Ohio State is making waves for suggesting atheists are inherently smarter than Christians. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins