Impact of Repositioning During Transcatheter Aortic Valve Replacement on Embolized Debris

Use of the dual-filter cerebral embolic protection (CEP) device has been linked to a lower stroke rate in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR). Captured debris is found in almost every filter. The impact of repositioning on number and area of captured debris has not been studied.

Consecutive patients (n = 200) undergoing transfemoral TAVR with double-filter CEP device were included. A total of 400 filters were analyzed. Histopathologic assessment and histomorphometric analyses of debris were compared for TAVR procedures with vs without repositioning. Analyses were differentiated by particle size, particle count, and total particle area.

Repositioning was used in 23/200 TAVR procedures (11.5%). Baseline data including sex, diabetes mellitus, and predilation were similar between patients with and without repositioning. Repositioning was associated with a significantly higher number of embolized debris (349 ± 326 vs 509 ± 495; P<.04) and larger debris area in both filters (15.56 ± 22.13 mm² vs 38.9 ± 25.57 mm²; P<.001) when compared with patients with no valve prosthesis repositioning. Periprocedural stroke rate was statistically not different between the two groups (0.0% vs 2.8%; P=.41), with use of CEP in all patients. Renal failure occurred significantly more often with repositioning of the TAVR prosthesis (8.7% vs 1.7% in patients without repositioning; P<.05) due to a significantly higher volume of contrast (139 ± 181 mL in patients with valve repositioning vs 85 ± 35 mL in patients without valve repositioning; P<.001).

Repositioning of the valve prosthesis during TAVR is associated with a larger number and higher total area of embolized debris captured with the dual-filter CEP device.