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Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
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Site Variability in Cerebral Embolic Protection for Transcatheter Aortic Valve Implantation and Association With
Aamer Ubaid1, Kevin F Kennedy2, Adnan K Chhatriwalla1,2
1Department of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA.
Structural Heart : the Journal of the Heart Team
|December 4, 2023
Summary
Most US hospitals do not use cerebral embolic protection devices (CEPD) during transcatheter aortic valve implantation (TAVI). Their use showed no significant difference in stroke or death rates, but increased hospitalization costs.
Area of Science:
- Cardiovascular Medicine
- Neurosurgery
- Health Services Research
Background:
- Cerebral embolic protection devices (CEPD) effectiveness in reducing stroke after transcatheter aortic valve implantation (TAVI) is unclear.
- CEPD utilization varies across US hospitals.
Purpose of the Study:
- To analyze hospital-level patterns of CEPD use during TAVI in the US.
- To investigate the association between CEPD use and patient outcomes.
Main Methods:
- Analysis of the 2019 Nationwide Readmissions Database for patients undergoing nontransapical TAVI.
- Hospitals categorized as CEPD non-users or CEPD users.
- Risk-adjusted logistic regression to compare in-hospital stroke/TIA, ischemic stroke, death, and hospitalization costs.
Main Results:
- CEPD were used in 10.6% of 41,822 TAVI encounters across 392 hospitals.
- No significant differences in stroke, TIA, or death rates between CEPD non-user and user hospitals.
- Hospitalization costs were lower in CEPD non-user hospitals.
Conclusions:
- Two-thirds of US hospitals do not use CEPD for TAVI.
- No significant association found between CEPD use and improved neurologic outcomes.
- Current evidence does not support routine CEPD use for TAVI based on observed outcomes and costs.
