Effect of Rapid Ventricular Pacing on Cerebral Oxygenation in Transcatheter Aortic Valve Implantation (TAVI): Role of Routine Near-Infrared Spectroscopy Monitorization
Pelin Karaaslan1, Kamil Darçın2, Arda Özyüksel3, Esra Kutlu1, Emine Arzu Köse1, Bilal Boztosun4, Atıf Akçevin3
1Department of Anesthesiology and Reanimation, Istanbul Medipol University, Istanbul, Turkey
2Department of Anesthesiology and Reanimation, Istanbul Koç University, Istanbul, Turkey
3Department of Cardiovascular Surgery, Istanbul Medipol University, Istanbul, Turkey
4Department of Cardiology, Istanbul Medipol University, Istanbul, Turkey
PURPOSE: Transcatheter aortic valve replacement (TAVI) have become an important treatment modality in patients with high risk comorbidities for surgical aortic valve replacement (SAVR). The objective of this study is to evaluate the cerebral perfusion status using near infrared spectroscopy (NIRS) method especially during the rapid ventricular pacing phase of the TAVI procedure. METHODS: 20 consecutive patients undergoing trans-femoral TAVI procedure between May 2015 and March 2016 in our institute were retrospectively evaluated. The periprocedural cerebral oxygenation was measured with a NIRS sensor (INVOSTM-5100 C, Medtronic Inc., Minneapolis, MI, USA) located on the forehead of the patients. All hemodynamic data and cerebral NIRS values were recorded before, during and after the procedure with constant time intervals, especially at the time of RVP and device deployment. RESULTS: The mean age was 74.4 ± 9.2 years. Male female ratio was 1.8 to 1 (13 males, 7 females). Mean procedure time was 70.2 ± 14.3 minutes. The rapid ventricular pacing included two episodes with a total time for pacing of 22.6 ± 5.1 seconds. There was a statistically significant difference with regard to the heart rate and the cerebral NIRS values (p=0.006 and p=0.02; respectively) in all patients during the RVP period. The cerebral NIRS values were statistically lower than baseline (pre-RVP) levels (p<0.001). CONCLUSIONS: This observational study presents the significant decrease of cerebral NIRS values during the rapid ventricular pacing phase of the TAVI procedure. Further studies may reveal cut-off values both for NIRS values and rapid ventricular pacing duration in order to determine a critical cut-off level.
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