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Published on: June 3, 2018
Cerebral embolic protection device utilization and outcomes in transcatheter aortic valve replacement: A nationally
Ahmed M Altibi1, Laith Alhuneafat2, Ahmad Jabri3
1Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA.
Insights
Cerebral embolic protection devices (CEPD) did not reduce stroke risk in transcatheter aortic valve replacement (TAVR) patients. This study found no significant difference in in-hospital or 30-day stroke or mortality rates with CEPD use.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Neurosurgery
Background:
- Transcatheter aortic valve replacement (TAVR) is increasingly common.
- Cerebral embolic protection devices (CEPD) are used to mitigate stroke risk during TAVR.
- Data on CEPD utilization trends and outcomes in TAVR is limited.
Purpose of the Study:
- To evaluate the trends and outcomes of cerebral embolic protection device (CEPD) usage in patients undergoing transcatheter aortic valve replacement (TAVR).
- To determine if CEPD use is associated with a reduced risk of periprocedural stroke and mortality in TAVR patients.
Main Methods:
- Analysis of the National Readmission Database (NRD) from 2017-2019.
- Identification of TAVR admissions with and without Sentinel CEPD using ICD-10 codes.
- Propensity score matching (PSM) and logistic regression to compare in-hospital and 30-day stroke, mortality, and other complications.
Main Results:
- Out of 190,837 TAVR admissions, 5.6% used Sentinel CEPD.
- In the PSM cohort (10,503 with CEPD, 10,541 without), CEPD was not associated with reduced in-hospital stroke (1.9% vs 1.8%), 30-day stroke (2.1% vs 2.1%), or 30-day mortality (1.3% vs 1.0%).
- No significant impact of CEPD on other procedural complications was observed.
Conclusions:
- Sentinel CEPD utilization in transfemoral TAVR was not associated with a significant reduction in stroke or mortality.
- Further research is needed to identify patient subsets who may benefit from CEPD.
- Optimizing patient selection and developing predictive models for stroke risk are crucial for future CEPD use.
Introduction:
In patients undergoing transcatheter aortic valve replacement (TAVR), cerebral embolic protection devices (CEPD) are used to possibly diminish the risk of periprocedural stroke. Trends and outcomes of CEPD usage in TAVR are not well characterized.
Methods:
National readmission databases (NRD) 2017-2019 was used to identify hospital admissions for TAVR using ICD-10 codes, with versus without Sentinel CEPD. Primary outcomes of the study were in-hospital and 30-day stroke. Secondary outcomes include in-hospital mortality, 30-day mortality, 30-day readmission rate, and other procedural complications. We matched both cohorts using propensity score matching (PSM) and performed logistic regression to compute the odds ratios (ORs) and corresponding 95 % confidence intervals (CI).
Results:
Out of 190,837 TAVR admissions in the United States, 10,643 (5.6 %) patients had TAVR with Sentinel CEPD. After propensity score matching, our cohort included 10,503 patients with CEPD and 10,541 without CEPD. Trends in CEPD utilization are noted in Fig. 1. In the PSM cohort, Sentinel CEPD was not associated with decreased risk of in-hospital stroke (1.9 % vs. 1.8 %, OR: 0.98, 95 % CI: 0.76-1.26, p = 0.88), 30-day stroke (2.1 % vs. 2.1 %, OR: 1.01, 95 % CI: 0.78-1.30, p = 0.96), or 30-day mortality (1.3 % vs. 1.0 %, OR: 0.74, 95 % CI: 0.51-1.07, p = 0.11) when compared to TAVR without CEPD. Other in-hospital and short-term outcomes post-TAVR were not impacted by Sentinel CEPD usage, including acute kidney injury, vascular complications, paravalvular leak, cardiogenic shock, circulatory support, or permanent pacemaker (Table 1).
Conclusion:
In this nationally representative cohort, Sentinel CEPD utilization during transfemoral TAVR for stroke prevention was not associated with reduced odds of in-hospital stroke, 30-day stroke, or 30-day mortality. Future studies should focus on optimizing patient selection for CEPD and establishing predictive models to identify the subset of TAVR patients with higher risk for periprocedural stroke who might benefit from CEPD.
