Transcranial Doppler sound detection of cerebral microembolism during transapical XXXX .

@entity1 @entity7303 @entity999 @entity886
OBJECTIVE: Transapical @entity886 (TAVI) is a new method that might reduce the surgical risk of conventional surgical aortic valve replacement in very high-risk @entity1 . Increased downstream microembolization is expected in transapical @entity886 . However, whether it usually occurs, how often, and its clinical relevance are not known. We report the results of ultrasound microembolic signal detection in the middle cerebral artery during the procedure. METHODS: Fifty @entity1 (mean age: 80    5 years; mean EuroSCORE: 36    13 %) underwent transapical @entity886 . Intraoperative transcranial Doppler (TCD) sound examination of both middle cerebral arteries (MCA) was used to identify high-intensity transient signals (HITS) and @entity7303 ( @entity7303 ) during seven phases of the procedure. Pre- and postoperative computed tomography of the brain and clinical neurological examinations were performed preoperatively and daily during the first postoperative week. RESULTS: During the procedure, HITS [right MCA: 435    922 (range 9-5765); left MCA: 471    996 (range 24-6432)] and @entity7303 [right MCA: 78    172 (range 1-955); left MCA: 62    190 (range 2-1553)] were detected in all @entity1 . Most of the @entity7303 were recorded during valvuloplasty [right MCA: 3    5.6 (range 0-31); left MCA: 2    4.9 (range 0-30)] and positioning of the prosthetic valve in the aortic position [right MCA: 6    5 (range 0-22); left MCA: 2    6.9 (range 0-38)]. Postoperatively, there were no clinical signs of new @entity999 . CONCLUSIONS: Cerebral microemboli were detected by intraoperative transcranial Doppler sound examinations in all @entity1 during transapical @entity886 . Most of the signals were detected during balloon valvuloplasty and delivery of the prosthetic valve.
