Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/126672
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Type: Journal article
Title: Meta-analysis of prevalence and risk factors for cognitive decline and improvement after transcatheter aortic valve implantation
Author: Ghezzi, E.S.
Ross, T.J.
Davis, D.
Psaltis, P.J.
Loetscher, T.
Keage, H.A.D.
Citation: American Journal of Cardiology, 2020; 127:105-112
Publisher: Elsevier
Issue Date: 2020
ISSN: 0002-9149
1879-1913
Statement of
Responsibility: 
Erica S.Ghezzi, Tyler J.Ross, Daniel Davis, Peter J.Psaltis, Tobias Loetscher, Hannah A.D.Keage
Abstract: Changes to cognition, both decline and improvement, are commonly reported after transcatheter aortic valve implantation (TAVI). However, previous systematic reviews and meta-analyses have missed these subgroups by assessing whole-group-averages for cognitive outcomes. We sought to pool estimates to identify the prevalence of cognitive decline and improvement after TAVI, as well as associated factors for these outcomes. A systematic review identified 15 articles appropriate for meta-analysis. When robust cognitive change definitions were employed, the pooled prevalence of incident cognitive impairment up to 1-, 1 to 6-, and ≥6-months post-TAVI was 7%, 14%, and 12%, respectively. For cognitive improvement, the prevalence from 1 to 6 months and ≥6 months after TAVI was estimated to be 19% and 11%, respectively. Two factors were associated with these cognitive outcomes: (1) using a cerebral embolic protection device was associated with decreased prevalence of cognitive decline up to 1-week post-TAVI; (2) baseline cognitive impairment had a large association with post-TAVI cognitive improvement. In conclusion, cognitive decline and cognitive improvement are experienced by approximately 7% to 19% of patients after TAVI, respectively. Those with the lowest cognitive performance pre-TAVI appear to have the most to gain in terms of cognitive improvement post-TAVI. Identifying further predictive factors for cognitive decline and improvement post-TAVI will facilitate a personalized-medicine approach for cognitive care and prognosis.
Keywords: Humans
Aortic Valve Stenosis
Postoperative Complications
Prevalence
Risk Factors
Cognition
Recovery of Function
Global Health
Transcatheter Aortic Valve Replacement
Cognitive Dysfunction
Rights: © 2020 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license
DOI: 10.1016/j.amjcard.2020.04.023
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