Transcatheter aortic valve replacement: perioperative stroke and beyond

Introduction: The definition of stroke has changed over time, from a clinical only-based diagnosis to a more complex classification, including both clinical and imaging-based criteria, in part due to widespread use of magnetic resonance imaging (MRI). The increasing number of transcatheter aortic valve replacement (TAVR) procedures in patients with severe aortic valvular stenosis who are considered high-risk surgical candidates has influenced our view on the diagnosis, interpretation, and significance of perioperative stroke during these procedures. Areas covered: In this perspective, we summarize changes in the definition and diagnostic criteria for stroke and transient ischemic attacks. We examine how the introduction of MRI and standardized cognitive tests has affected our understanding of the safety of TAVR procedures. Finally, we review the growing evidence regarding the role of cerebral protection technology during TAVR procedures on cognitive function. Expert commentary: Standardized MRI-based protocols and prospective evaluation of neurologic deficits with a battery of cognitive assessment tests are needed to ensure accurate recognition of postprocedural clinical events in patients undergoing TAVR procedures and to confirm the effectiveness of embolic protection technology.