Comparison of subclinical neuronal injury by measuringneuron-specific enolase in patients with severeaortic stenosis treated with transcatheter aortic valvereplacement or sutureless aortic valve replacement

Aim: Severe aortic valve stenosis (SAVS) which causes angina pectoris, syncope, arrhythmias, and sudden cardiac death, may be treated with transcatheter aortic valve replacement (TAVR) or sutureless aortic valve replacement (SU-AVR). We aimed to predict subclinical neuronal injury (SNI) by measuring neuron-specific enolase (NSE) in patients who underwent the TAVR and the SU-AVR.Materials and Methods: This clinical trial was carried out between January 2015 and January 2017. A total of 53 patients who had severe aortic valve stenosis (SAVS) and underwent TAVR and SU-AVR were included. The Serum NSE level was measured just before and 24 hours after the procedure. Demographic variables, neurologic assessment findings, clinical and echocardiographic data, carotid ultrasounds reports, and laboratory findings were recorded.Results: A total of 53 patients were included the study. The mean age was 78.4±8.6 and 20 were man (37.7%). The mean age of the TAVR group was significantly higher than the SU-AVR group (82.9±4.7 vs 71.5±8.7, p

PDF

___

1. Grabert S, Lange R, Bleiziffer S. Incidence and causes of silent and symptomatic stroke following surgical and transcatheter aortic valve replacement: a comprehensive review. Interact Cardiovasc Thorac Surg 2016;23:469-76.
2. Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC)1; European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012;33:2451-96.
3. D'Onofrio A, Rizzoli G, Messina A, et al. Conventional surgery, sutureless valves, and transapical aortic valve replacement: what is the best option for patients with aortic valve stenosis? A multicenter, propensity-matched analysis. J Thorac Cardiovasc Surg 2013;146:1065-70.
4. Costine BA, Quebeda-Clerkin PB, Dodge CP, et al. Neuron-specific enolase, but not S100B or myelin basic protein, ıncreases in peripheral blood corresponding to lesion volume after cortical ımpact in piglets. J Neurotrauma 2012;29:2689-95.
5. Wunderlich MT, Ebert AD, Kratz T, et al. Early neurobehavioral outcome after stroke is related to release of neurobiochemical markers of brain damage. Stroke 1999;30:1190-5.
6. Rosén H, Sunnerhagen KS, Herlitz J, et al. Serum levels of the brain-derived proteins S-100 and NSE predict long-term outcome after cardiac arrest. Resuscitation 2001;49:183-91.
7. Rech TH, Vieira SR, Nagel F, et al. Serum neuronspecific enolase as early predictor of outcome after in-hospital cardiac arrest: a cohort study. Crit Care 2006;10:133.
8. Pattoneri P1, Sozzi FB, Catellani E, et al. Myocardial involvement during the early course of type 2 diabetes mellitus: usefulness of myocardial performance index. Cardiovasc Ultrasound 2008;6:27.
9. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation And Treatment of High Blood Cholesterol İn Adults (Adults Treatment Panel III). JAMA 2001;285:2486-97.
10. Tam DY, Vo TX, Wijeysundera HC, et al. Transcatheter vs Surgical Aortic Valve Replacement for Aortic Stenosis in Low-Intermediate Risk Patients: A Metaanalysis. Can J Cardiol 2017;33:1171-9.
11. Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients.N Engl J Med. 2011;364:2187-98.
12. Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.N Engl J Med 2010;363:1597-607.
13. Kodali SK, Williams MR, Smith CR, et all. Two-year outcomes after transcatheter or surgical aortic-valve replacement.N Engl J Med 2012;366:1686-95.
14. Miller DC, Blackstone EH, Mack MJ, et al. Transcatheter (TAVR) versus surgical (AVR) aortic valve replacement: occurrence, hazard, risk factors, and consequences of neurologic events in the PARTNER trial.J Thorac Cardiovasc Surg 2012;143:832-843.e13.
15. Alassar A, Soppa G, Edsell M, et al. Incidence and mechanisms of cerebral ıschemia after transcatheter aortic valve ımplantation compared with surgical aortic valve replacement. Ann Thorac Surg 2015;99:802-8.
16. Kahlert P, Knipp SC, Schlamann M, et al. Silent and apparent cerebral ischemia after percutaneoustransfemoral aortic valve implantation: a diffusion-weightedmagnetic resonance imaging study. Circulation 2010;121:870-8.
17. Ghanem A, Müller A, Nähle CP, et al. Risk and fate of cerebral embolism after transfemoral aortic valve implantation: a prospective pilot study with diffusionweighted magnetic resonance imaging.J Am Coll Cardiol 2010;55:1427-32.
18. Grabert S, Lange R, Bleiziffer S. Incidence and causes of silent and symptomatic stroke following surgical and transcatheter aortic valve replacement: a comprehensive review. Interact CardioVasc Thorac Sur 2016;23:469-76.
19. Di Eusanio M, Phan K. Sutureless aortic valve replacement Ann Cardiothorac Surg 2015;4:123-30.
20. Borger MA, Moustafine V, Conradi L, et al. A randomized multicenter trial of minimally invasive rapid deployment versus conventional full sternotomy aortic valve replacement. Ann Thorac Surg 2015;99:17-25.
21. Phan K, Tsai YC, Niranjan N, et al. Sutureless aortic valve replacement: a systematic r eview and metaanalysis. Ann Cardiothorac Surg 2015;4:100-11.
22. Santarpino G, Pfeiffer S, Jessl J,et al. Sutureless replacement versus transcatheter valve implantation in aortic valve stenosis: a propensity-matched analysis of 2 strategies in high-risk patients.J Thorac Cardiovasc Surg 2014;147:561-7.
23. Muneretto C, Bisleri G, Moggi A, et al. Treating the patients in the 'grey-zone' with aortic valve disease: a comparison among conventional surgery, sutureless valves and transcatheter aortic valve replacement. Interact Cardiovasc Thorac Surg 2015;20:90-5.
24. Fanning JP, See Hoe LE, Passmore MR, et al. NeuronSpecific Enolase and Matrix Metalloproteinase 9 Signal Perioperative Silent Brain Infarction During or After Transcatheter Aortic Valve Implantation. Am J Cardiol 2019;123:434-9.
25. Cunningham RT, Young IS, Winder J, et al. Serum neurone specific enolase (NSE) levels as an indicator of neuronal damage in patients with cerebral infarction. Eur J Clin Invest1991;21:497-500.
26. Baranyi A, Rothenhäusler HB. The impact of S100b and persistent high levels of neuron-specific enolase on cognitive performance in elderlypatients after cardiopulmonary bypass.Brain Inj 2013;27:417-24.
27. Herrmann M, Ebert AD, Galazky I, et al. Neurobehavioral outcome prediction after cardiac surgery: role of neurobiochemical markers of damage to neuronal and glial brain tissue.Stroke 2000;31:645-50.
28. Tiainen M, Roine RO, Pettilä V, Takkunen O. Serum neuron-specific enolase and S-100B protein in cardiac arrest patients treated with hypothermia. Stroke 2003;34:2881-6.
29. Weigl M, Moritz A, Steinlechner B, et al. Neuronal injury after repeated brief cardiac arrests during internal cardioverter defibrillator implantation is associated with deterioration of cognitive function. Anesth Analg 2006;103:403-9