Cognitive and functional status after transcatheter and mini-aortic valve replacement: a prospective cohort study

Retrospective data suggest that cognitive function changes after transcatheter (TAVR) and surgical aortic valve replacement (SAVR) are equivalent overall and may even improve in some populations. Yet, the change in cognitive function after minimally-invasive AVR (miniAVR) remains to be defined. We sought to evaluate the change in cognitive function after minimally-invasive aortic valve replacement. This is a prospective cohort study of patients undergoing miniAVR or TAVR between 3/2020 and 9/2022. Baseline and postoperative neurocognitive status (early postoperative period, at 6 months, and 1 year) were assessed by Telephone-Montreal Cognitive Assessment (T-MoCA) and Activity Measure for Post-Acute Care—Applied Cognitive (AM-PAC-AC). Fifty patients underwent miniAVR (N = 30) or TAVR (N = 20). Baseline cognitive status was higher in miniAVR patients compared to TAVR patients (T-MoCA 20 versus 18 [p = 0.003]; AM-PAC-AC 54 versus 48, [p = 0.01]). Early postoperative cognitive function among miniAVR patients declined from baseline by T-MoCA (20 versus 19; p = 0.003) but not by AM-PAC-AC (54 versus 52; p = 0.21). At 6 months, however, cognitive function after miniAVR recovered to baseline (T-MoCA 20 vs. 20; p = 0.36; AM-PAC-AC 57 versus 54; p = 0.08). Postoperative cognitive function did not change from baseline after TAVR at any timepoint. At one-year follow-up (n = 35), there were no differences in cognitive decline by either score. Long-term cognitive function is preserved among patients after miniAVR and TAVR despite an early small postoperative cognitive decline. Cognitive and functional outcomes may be optimized by appropriate patient selection for either approach to aortic valve replacement.