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. 2022 Mar 15:3:100137.
doi: 10.1016/j.cccb.2022.100137. eCollection 2022.

Quantifying neurological function in patients undergoing transcatheter aortic valve implantation

Joanna S Semrau  1 , Stephen H Scott  1   2 , Andrew G Hamilton  3   4 , Dimitri Petsikas  3   4 , Darrin M Payne  3   4 , Gianluigi Bisleri  5   6 , Tarit Saha  3   7 , J Gordon Boyd  1   3   8
Affiliations

Quantifying neurological function in patients undergoing transcatheter aortic valve implantation

Joanna S Semrau et al. Cereb Circ Cogn Behav. .

Abstract

Background: Transcatheter aortic valve implantation (TAVI) is a routine procedure that is often performed on older adults that are high-risk patients with severe aortic stenosis. Patients after TAVI may experience neurological complications. However, there is a lack of objective neurological testing available for patients undergoing cardiac surgery.

Objective: This brief communication seeks to explore the use of robotic technology to quantify distinctive patterns of visuospatial, sensorimotor, and cognitive functioning in patients undergoing TAVI.

Methods: Patients undergoing TAVI were recruited for this prospective observational study. Prior to their procedure, study participants performed four robotic reaching tasks using the Kinarm robotic system. Patients repeated the assessment three months after their TAVI procedure. Significant changes in overall task score and parameters were determined.

Results: Ten patients were recruited and included in this brief report. In a simple reaching task, patients show significant improvement in performance post-TAVI. However, patients do not improve nor worsen in a complex reaching task after TAVI. Similarly, patients demonstrate impairments in both trail making tasks before and after their TAVI procedure.

Conclusions: This study captures the variability in neurological functioning in older patients undergoing TAVI. Robotic technology and quantified assessment procedures can be extremely valuable for detecting perioperative neurological impairments in this patient population.

Keywords: Neurological assessment; Post-operative cognitive impairment; Robotics; Transcatheter aortic valve implantation.

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Conflict of interest statement

JSS, AGH, DP, DMP, GB, and TS have nothing to disclose. SHS is the inventor of the Kinarm robot and co-founder of its distribution company, Kinarm. JGB receives a stipend for the Trillium of Life Network for his role as a hospital donation physician.

Figures

Fig 1
Fig. 1
A. Hand paths illustrating performance of Patient 3 on the Visually Guided Reaching (VGR) task before and 3 months after TAVI. Radar plots illustrating B. pre-operative and C. post-operative parameters on VGR. The area between the dashed lines represents average performance. Values greater than the black dashed line (1.64) signify impairment. Values less than the green dashed line (−1.64) signify greater than average performance. The solid black line represents zero on the plotting scale. *Denotes significant change in task score. Unfilled circles represent significant change in parameter value. Patients 2 and 5 did not participate in the 3-month assessment timepoint.
Fig 2
Fig. 2
A. Hand paths illustrating performance of Patient 7 on the Reverse visually guided reaching (RVGR) task before and 3 months after TAVI. Radar plots illustrating B. pre-operative and C. post-operative parameters on RVGR. The area between the dashed lines represents average performance. Parameters values greater than the black dashed line (1.64) signify impairment. Parameter values less than the green dashed line (-1.64) signify greater than average performance. The solid black line represents zero on the plotting scale. *Denotes significant change in task score. Unfilled circles represent significant change in parameter value. Patients 2 and 5 did not participate in the 3-month assessment timepoint.
Fig 3
Fig. 3
Radar plots illustrating A. pre-operative and B. post-operative parameters on the TMT-A task. The area between the dashed lines represents average performance. The black dashed line represents 1.64 on the plotting scale. The green dashed line represents -1.64 on the plotting scale. The solid black line represents zero on the plotting scale. *Denotes significant change in task score. Unfilled circles represent significant change in parameter value. Patient 9 was not available to complete the trail making task prior to their TAVI procedure.
Fig 4
Fig. 4
Radar plots illustrating A. pre-operative and B. post-operative parameters on the TMT-B task. The area between the dashed lines represents average performance. The black dashed line represents 1.64 on the plotting scale. The green dashed line represents -1.64 on the plotting scale. The solid black line represents zero on the plotting scale. *Denotes significant change in task score. Unfilled circles represent significant change in parameter value. Patient 9 was not available to complete the trail making task prior to their TAVI procedure.
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