Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• The efficacy of cerebral embolic protection devices (CEPDs) in reducing clinical stroke during transcatheter aortic valve replacement (TAVR) remains controversial.
• Investigating the impact of CEPDs on in-hospital stroke is crucial for optimizing TAVR procedures.

Purpose of the Study:

• To determine the impact of CEPDs on in-hospital clinical stroke rates in patients undergoing TAVR.
• To evaluate other clinical outcomes, including mortality, acute kidney injury, bleeding, and cost, associated with CEPD use during TAVR.

Main Methods:

• A retrospective analysis of the National Inpatient Sample (NIS) database from 2017-2018.
• Inclusion of 109,240 patients undergoing TAVR, categorized into CEPD and non-CEPD groups.
• Propensity score matching created 3805 pairs for comparative analysis of outcomes.

Main Results:

• In-hospital clinical stroke rates did not significantly differ between the CEPD (0.7%) and non-CEPD (1.1%) groups (p = 0.449).
• The CEPD group showed significantly lower in-hospital mortality (0.5% vs. 1.4%, p = 0.029) and reduced total costs (p < 0.001).
• No significant differences were observed in acute kidney injury, bleeding complications, or infectious complications between the groups.

Conclusions:

• CEPD use during TAVR was not associated with a reduced incidence of in-hospital clinical stroke in this large, nationally representative dataset.
• CEPDs may be associated with improved in-hospital mortality and cost-effectiveness in TAVR patients.