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|Title:||Meta-analysis of prevalence and risk factors for cognitive decline and improvement after transcatheter aortic valve implantation|
|Citation:||American Journal of Cardiology, 2020; 127:105-112|
|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|
|Appears in Collections:||Medicine publications|
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