Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement
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Published on: June 3, 2018
Fumiaki Yashima1, Alexandros Briasoulis2, Toshiki Kuno3
1Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan.
Insights
Cerebral embolic protection devices (CEPDs) did not reduce stroke during transcatheter aortic valve replacement (TAVR). However, CEPDs were linked to lower mortality and costs in this large-scale study.
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.
Background:
It is controversial that cerebral embolic protection devices (CEPDs) reduce clinical stroke during transcatheter aortic valve replacement (TAVR). Herein, we investigated the impact of CEPDs on in-hospital clinical stroke using a nationally representative sample.
Methods And Results:
Using the National Inpatient Sample (NIS) database, 109,240 patients who underwent TAVR between 2017 and 2018 were included. They were categorized into 2 groups according to usage of CEPDs; the CEPD and non-CEPD groups. After propensity score matching, 3805 pairs were acquired. Our main outcome was in-hospital clinical stroke. Other outcomes were in-hospital mortality, acute kidney injury (AKI), AKI leading to hemodialysis, bleeding requiring transfusion, overall bleeding complications, infectious complications, length of stay, and total cost. In-hospital clinical stroke did not significantly differ between the 2 groups (0.7% versus 1.1%, p = 0.449). The CEPD group was associated with a significantly lower in-hospital mortality (0.5% versus 1.4%, p = 0.029) and reduced total cost ($49,047 ± 19,666 versus $50,051 ± 23,190, p < 0.001), compared with the non-CEPD group, whereas there were no significant differences in the other outcomes.
Conclusions:
By using the NIS database with a large number of cases, TAVR with CEPDs was not associated with a lower incidence of in-hospital clinical stroke compared with no use of CEPDs after matching.
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