Can transcatheter aortic valve implantation improve cognition?

currently the preferred treatment for patients with severe aortic valve stenosis and high surgical risk. Recent trials have found better clinical outcomes in patients with lower surgical risk scores compared to surgical aortic valve replacement. Consequently, TAVI indication is rapidly expanding to patients with intermediate and low surgical risk [1]. Prevalence of aortic valve stenosis increases with age. Due to increasing life-expectancy, the number of elderly patients with aortic valve stenosis is rising. We previously showed that nonagenarians had worse TAVI outcomes than their younger counterparts. Despite fewer comorbidities, these patients had a twofold increase in mortality, more strokes and more major or life-threatening bleeding [2]. Patients with severe aortic valve stenosis have lower cognitive scores than age, sex, and education matched individuals [3]. Especially in older patients with smaller cognitive reserves, a small change in cognition can make the difference between living independently and becoming institutionalized. Previous studies have demonstrated that patients after TAVI have improved cognitive functioning. Khan et al. [4] conducted a meta-analysis of cognitive outcomes after TAVI of 1065 patients from eighteen studies. At one-month follow-up, overall cognition had improved in 287 patients collected from seven studies. Cognitive scores did not significantly change peri-procedurally or between baseline and longer-term follow-up up to two years. Of all patients in this meta-analysis 21-39% had cognitive impairment, although 40% of cognitive diagnoses were missing, and definitions and cut-off scores differed. Baseline cognitive impairment was not associated with cognitive changes at any moment in follow-up, neither was stroke or embolic lesions. This finding is in contrast with prior associations between stroke and cognitive decline. Sample sizes were small with only two studies representing more than 100 patients. [4] Cognitive changes are mostly subtle and different cognitive tests measure different cognitive domains. Pooling small datasets of different cognitive test methods may therefore not result in reliable data. Looking at seven studies that used the Montreal Cognitive Assessment (MoCA) [5], that was especially Editorial