{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:24:57Z","timestamp":1760059497194,"version":"build-2065373602"},"reference-count":29,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Despite the success of transcatheter aortic valve repair (TAVR) over the past years, its impact on global and cerebral hemodynamics remains largely unexplored. Changes in cerebral blood flow may be associated with delirium, which may occur in 26 to 29% of cases. We aimed to examine the relationships between global hemodynamic parameters and cerebral parameters in patients who underwent TAVR and their impact on postinterventional delirium. Methods: Patients scheduled for TAVR were enrolled after obtaining written informed consent. Patients received light sedation according to standard procedures. Cerebral blood flow (CBF) was measured with a noninvasive near-infrared spectroscopy-based method using intravenous indocyanine green injection. CBF measurements were taken at the beginning of the TAVR procedure and after the valve was in place. Patients were screened for delirium using CAM-ICU and NuDESC tests before and after intervention. Results: A total of 52 of 60 patients remained for analysis. Thirteen patients (25%) developed delirium. Mean arterial pressure (MAP) remained unchanged, while cardiac output increased after TAVR by 44%. CBF also increased after TAVR. No significant difference was observed in CBF changes between the groups with and without delirium. A linear mixed model analysis revealed a linear relationship between CO and CBF but not between MAP and CBF. In an exploratory analysis, decreased cerebral oxygenation and increased deoxygenated hemoglobin, as measured by NIRS after TAVR, were associated with delirium. Conclusions: The results confirm that CO is an independent factor in CBF, while CBF changes per se are not linked to delirium. However, we found a mismatch between CBF and regional cerebral parameters, which may reflect cerebral metabolism and its relation to the development of delirium. This remains to be confirmed by further studies.<\/jats:p>","DOI":"10.3390\/jcm14124317","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T10:45:26Z","timestamp":1750157126000},"page":"4317","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Regional Cerebral Blood Flow Increase After Transcatheter Aortic Valve Replacement Is Related to Cardiac Output but Is Not Associated with Delirium: An Observational Cohort Study Using Transcranial Indocyanine Green Dye Dilution Technique"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5959-7735","authenticated-orcid":false,"given":"Maximilian","family":"Oremek","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Nowotny","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Zimmer","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pulmonology, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6836-8536","authenticated-orcid":false,"given":"Atsushi","family":"Sugiura","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pulmonology, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonie","family":"Weinhold","sequence":"additional","affiliation":[{"name":"Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn, 53127 Bonn, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5923-3410","authenticated-orcid":false,"given":"Juerg","family":"Froehlich","sequence":"additional","affiliation":[{"name":"Fields and More GmbH, 8032 Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5962-8746","authenticated-orcid":false,"given":"Martin","family":"Soehle","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5643-0294","authenticated-orcid":false,"given":"Andr\u00e9","family":"Diedrich","sequence":"additional","affiliation":[{"name":"Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0586-9242","authenticated-orcid":false,"given":"Marcus","family":"Thudium","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2635","DOI":"10.1093\/eurheartj\/ehy107","article-title":"Annual Number of Candidates for Transcatheter Aortic Valve Implantation per Country: Current Estimates and Future Projections","volume":"39","author":"Durko","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Van Houte, J., Eerdekens, R., Dieters, E., Te Pas, M., Wijnbergen, I., Tonino, P., and Bouwman, A. (2023). Immediate Hemodynamic Effects of Transcatheter Aortic Valve Replacement on Left Ventricular Stroke Volume and Carotid Artery Blood Flow. WFUMB Ultrasound Open, 1.","DOI":"10.1016\/j.wfumbo.2023.100008"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1016\/j.jtcvs.2015.10.114","article-title":"Delirium after Surgical and Transcatheter Aortic Valve Replacement Is Associated with Increased Mortality","volume":"151","author":"Maniar","year":"2016","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1111\/jgs.15867","article-title":"Delirium Incidence and Functional Outcomes After Transcatheter and Surgical Aortic Valve Replacement","volume":"67","author":"Shi","year":"2019","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Thudium, M., Ellerkmann, R.K., Heinze, I., and Hilbert, T. (2019). Relative Cerebral Hyperperfusion during Cardiopulmonary Bypass Is Associated with Risk for Postoperative Delirium: A Cross-Sectional Cohort Study. BMC Anesthesiol., 19.","DOI":"10.1186\/s12871-019-0705-y"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1016\/S1053-8119(03)00315-X","article-title":"Noninvasive Measurement of Regional Cerebral Blood Flow and Regional Cerebral Blood Volume by Near-Infrared Spectroscopy and Indocyanine Green Dye Dilution","volume":"20","author":"Keller","year":"2003","journal-title":"NeuroImage"},{"key":"ref_7","first-page":"98","article-title":"Die Nursing Delirium Screening Scale (Nu-DESC)\u2014Richtlinienkonforme \u00dcbersetzung f\u00fcr den deutschsprachigen Raum","volume":"43","author":"Radtke","year":"2008","journal-title":"AINS-An\u00e4sthesiologie Intensivmed. Notfallmedizin\u00b7Schmerzther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/j.bja.2024.06.035","article-title":"Regional Cerebral Blood Flow Is Compromised during Robotic Surgery in the Trendelenburg Position, but Not during Surgery in the Beach Chair Position: An Observational Study","volume":"133","author":"Oremek","year":"2024","journal-title":"Br. J. Anaesth."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/S0163-8343(01)00117-7","article-title":"Preoperative Risk Factors for Postoperative Delirium","volume":"23","author":"Litaker","year":"2001","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1093\/icvts\/ivt323","article-title":"Delirium after Cardiac Surgery: Incidence and Risk Factors","volume":"17","author":"Smulter","year":"2013","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e243","DOI":"10.1016\/j.bja.2022.01.006","article-title":"Processed Electroencephalography-Guided General Anaesthesia to Reduce Postoperative Delirium: A Systematic Review and Meta-Analysis","volume":"130","author":"Sumner","year":"2023","journal-title":"Br. J. Anaesth."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1016\/S1474-4422(05)70251-9","article-title":"Cerebral Hyperperfusion Syndrome","volume":"4","author":"Rennenberg","year":"2005","journal-title":"Lancet Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2132","DOI":"10.1177\/0271678X18783369","article-title":"Flow-Metabolism Uncoupling in Patients with Asymptomatic Unilateral Carotid Artery Stenosis Assessed by Multi-Modal Magnetic Resonance Imaging","volume":"39","author":"Kaczmarz","year":"2019","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.jalz.2013.04.507","article-title":"Global Brain Hypoperfusion and Oxygenation in Amnestic Mild Cognitive Impairment","volume":"10","author":"Liu","year":"2014","journal-title":"Alzheimer\u2019s Dement."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Yilmaz Ak, H., Sandal, B., Ozsahin, Y., Salihoglu, Z., Yildiz, A., Erturk Tekin, E., Yesiltas, M.A., Yildiz, M., and Erkalp, K. (2025). Association between Periprocedural Cerebral Desaturation during Transcatheter Aortic Valve Implantation and Postprocedural Delirium: A Prospective Observational Study. BMC Anesthesiol., 25.","DOI":"10.1186\/s12871-025-02950-1"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.freeradbiomed.2016.12.039","article-title":"Intraoperative Cerebral Oxygenation, Oxidative Injury, and Delirium Following Cardiac Surgery","volume":"103","author":"Lopez","year":"2017","journal-title":"Free Radic. Biol. Med."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Jurcau, A., and Simion, A. (2022). Neuroinflammation in Cerebral Ischemia and Ischemia\/Reperfusion Injuries: From Pathophysiology to Therapeutic Strategies. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23010014"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1007\/s00401-010-0674-1","article-title":"The Neuroinflammatory Hypothesis of Delirium","volume":"119","author":"Cerejeira","year":"2010","journal-title":"Acta Neuropathol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Thudium, M., Braun, L., Stroemer, A., Mayr, A., Menzenbach, J., Saller, T., Soehle, M., Kornilov, E., and Hilbert, T. (2024). Cerebral Overperfusion Despite Reduced Cortical Metabolism Is Associated with Postoperative Delirium in Cardiac Surgery Patients: A Prospective Observational Study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13216605"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2686","DOI":"10.1016\/j.clinthera.2015.10.021","article-title":"The Association of Brain MRI Characteristics and Postoperative Delirium in Cardiac Surgery Patients","volume":"37","author":"Brown","year":"2015","journal-title":"Clin. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2022","DOI":"10.1097\/CCM.0b013e318250acc0","article-title":"The Association between Brain Volumes, Delirium Duration, and Cognitive Outcomes in Intensive Care Unit Survivors: The VISIONS Cohort Magnetic Resonance Imaging Study*","volume":"40","author":"Gunther","year":"2012","journal-title":"Crit. Care Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1093\/bja\/aeu319","article-title":"Arterial Pressure above the Upper Cerebral Autoregulation Limit during Cardiopulmonary Bypass Is Associated with Postoperative Delirium","volume":"113","author":"Hori","year":"2014","journal-title":"Br. J. Anaesth."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1016\/j.jacc.2009.12.026","article-title":"Risk and Fate of Cerebral Embolism After Transfemoral Aortic Valve Implantation","volume":"55","author":"Ghanem","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"N\u00fcbel, J., Buhre, C., Hoffmeister, M., Oess, S., Labrenz, O., Jost, K., Hauptmann, M., Sch\u00f6n, J., Fritz, G., and Butter, C. (2023). Association between Neuron-Specific Enolase, Memory Function, and Postoperative Delirium after Transfemoral Aortic Valve Replacement. J. Cardiovasc. Dev. Dis., 10.","DOI":"10.3390\/jcdd10110441"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1097\/ALN.0000000000002838","article-title":"Internal Carotid Artery Blood Flow Response to Anesthesia, Pneumoperitoneum, and Head-up Tilt during Laparoscopic Cholecystectomy","volume":"131","author":"Skytioti","year":"2019","journal-title":"Anesthesiology"},{"key":"ref_26","first-page":"162","article-title":"Acute Invasive Hemodynamic Effects of Transcatheter Aortic Valve Replacement","volume":"25","author":"Chrissoheris","year":"2016","journal-title":"J. Heart Valve Dis."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Brassard, P., Labrecque, L., Smirl, J.D., Tymko, M.M., Caldwell, H.G., Hoiland, R.L., Lucas, S.J.E., Denault, A.Y., Couture, E.J., and Ainslie, P.N. (2021). Losing the Dogmatic View of Cerebral Autoregulation. Physiol. Rep., 9.","DOI":"10.14814\/phy2.14982"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1152\/physrev.1959.39.2.183","article-title":"Cerebral Blood Flow and Oxygen Consumption in Man","volume":"39","author":"Lassen","year":"1959","journal-title":"Physiol. Rev."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Menzenbach, J., Kirfel, A., Guttenthaler, V., Feggeler, J., Hilbert, T., Ricchiuto, A., Staerk, C., Mayr, A., Coburn, M., and Wittmann, M. (2022). PRe-Operative Prediction of Postoperative DElirium by Appropriate SCreening (PROPDESC) Development and Validation of a Pragmatic POD Risk Screening Score Based on Routine Preoperative Data. J. Clin. Anesth., 78.","DOI":"10.1016\/j.jclinane.2022.110684"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/12\/4317\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:53:36Z","timestamp":1760032416000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/12\/4317"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,17]]},"references-count":29,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["jcm14124317"],"URL":"https:\/\/doi.org\/10.3390\/jcm14124317","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,6,17]]}}}