None listed
Conditions
Brief summary
Aortic stenosis is a common condition caused by a narrowing of the aortic valve that can be resolved by replacing the valve. Traditionally this has been performed with open-heart surgery, which is effective but may be associated with significant complications. Transcatheter aortic valve intervention (TAVI) is an alternative to surgical replacement that has resulted in improved results for patients at high and intermediate risk for surgery. It is understood that surgical valve replacement may negatively affect cognitive function, though the effect of TAVI on cognitive function is less clear; relieving the narrowing improves blood flow to the brain and may improve cognition, however, the procedure may lead to small blood clots being sent to the brain that limit this improvement. In this study, we are looking to examine whether patients who undergo the different aortic valve procedures may have disturbances in the blood flow in their brain after the procedure and how this affects mental performance. We will use transcranial Doppler ultrasound (TCD) to measure blood flow in the brain during a series of mental tests and compare the results before and after the procedure.
Interventions
We aim to perform a prospective study of the relationship between changes in cerebral blood flow and cognitive function (neurovascular coupling) in a cohort of patients undergoing aortic valve intervention. We aim to assess patients undergoing both transcatheter (TAVI) and traditional surgical aortic valve (SAVI) intervention to document changes in cerebral blood responses following aortic valve replacement by evaluating patients before and within three to six months after their aortic valve pro
We aim to perform a prospective study of the relationship between changes in cerebral blood flow and cognitive function (neurovascular coupling) in a cohort of patients undergoing aortic valve intervention. We aim to assess patients undergoing both transcatheter (TAVI) and traditional surgical aortic valve (SAVI) intervention to document changes in cerebral blood responses following aortic valve replacement by evaluating patients before and within three to six months after their aortic valve procedures. Participants will attend the research clinic at the University of Newcastle on two occasions. Visits will last up to one and a half hours each. Anthropometric measurements of height, weight and waist circumference will be obtained before the clinic BP is assessed. A headpiece supporting a transcranial doppler (TCD) ultrasound probe on each temporal region will be fitted to patients. It may take up to 15 minutes to find a signal. The ultrasound will continuously record changes in the blood velocities in the MCA during the cognitive test battery. Global cognition will be assessed using the Addenbrooke’s Cognitive Examination-III (ACE-III). Trail Making Task will be assessed by pen-paper modality. Spatial Forward Span test. Controlled Oral Word Association Test. Digit Symbol Coding. Psychomotor speed will be assessed using the 9-hole Pegboard Dexterity test. Pattern Comparison Processing Speed Test (NIH-ToolBox). Cognitive testing will take approximately 35 minutes. After the cognitive tests, the investigator will adjust the ultrasound probes to locate the posterior cerebral arteries. Once a suitable blood flow signal is located, participants will be asked to open and close their eyes as guided by the investigator. Mood will be assessed using: The Center for Epidemiologic Studies Depression Scale (CES-D) and The State-Trait Anxiety Inventory (STAI). Quality of life will be assessed using the short-form 36 (SF-36). The visits will be conducted by an experienced Research Assistant, overseen by the Clinical Trials Coordinator.
Sponsors
Dr Nicholas Collins
Eligibility
Sex/Gender
All
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
15 patients with aortic stenosis undergoing surgical aortic valve intervention and 15 patients undergoing transcatheter aortic valve intervention. Age > 18 years
Exclusion criteria
Unable to obtain a measurable signal in either left or right MCA. Uncontrolled hypertension (>160/100mmHg). Pregnant women and people highly dependent on medical care.
Outcome results
None listed