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Published on: February 26, 2013
Outcomes and Predictors of Stroke After Transcatheter Aortic Valve Replacement in the Cerebral Protection Device Era
Shashank Shekhar1, Toshiaki Isogai1, Ankit Agrawal1
1Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA.
Insights
Cerebral protection devices (CPDs) during transcatheter aortic valve replacement did not lower overall stroke risk but reduced major strokes. CPD use was linked to better outcomes, including shorter hospital stays and lower readmissions.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Neurosurgery
Background:
- Transcatheter aortic valve replacement (TAVR) is a growing procedure for aortic stenosis.
- The effectiveness of cerebral protection devices (CPDs) in preventing stroke during TAVR remains debated.
- Existing studies report inconclusive findings regarding CPDs' impact on neurological outcomes.
Purpose of the Study:
- To investigate the association between cerebral protection device (CPD) use and stroke rates in TAVR patients.
- To analyze national data on stroke incidence and other clinical outcomes in TAVR procedures with and without CPDs.
- To evaluate the impact of CPDs on major stroke, mortality, length of stay, and readmission rates.
Main Methods:
- Analysis of the Nationwide Readmissions Database (2017-2020).
- Inclusion of patients who underwent transcatheter aortic valve replacement (TAVR).
- Comparison of outcomes between patients with and without CPD use using multivariable logistic regression.
Main Results:
- CPD use was not associated with lower overall stroke rates (1.6% vs. 1.9%).
- CPD use was significantly associated with lower major stroke rates (1.2% vs. 1.5%; P=0.02).
- CPD cohort showed shorter length of stay, higher routine discharge rates, lower mortality, and reduced 30- and 180-day readmissions.
Conclusions:
- CPD use during TAVR is not independently linked to reduced overall stroke risk.
- CPD use is associated with a lower risk of major stroke.
- Further randomized trials are needed to clarify patient selection and confirm benefits, addressing potential confounders.
Background:
Studies have shown inconclusive results on the effectiveness of cerebral protection devices (CPDs) with transcatheter aortic valve replacement. We aimed to analyze the national statistics on stroke and other outcomes with CPD use.
Methods And Results:
The Nationwide Readmissions Database (2017-2020) was queried to obtain data on patients undergoing transcatheter aortic valve replacement. Outcomes were compared between patients with a CPD and patients without a CPD. Of 271 804 patients undergoing transcatheter aortic valve replacement, CPD was used in 7.3% of patients. In a multivariable logistic regression analysis, CPD use was not associated with lower overall stroke rates (1.6% versus 1.9% without CPD; odds ratio, 0.95 [95% CI, 0.84-1.07]; P=0.364), but it was significantly associated with lower major stroke rates (1.2% versus 1.5% without CPD; odds ratio, 0.85 [95% CI, 0.74-0.98]; P=0.02). Patients with a CPD also had a shorter length of stay, higher routine discharges to home/self-care (74.9% versus 70.6%), and lower mortality rates (0.7% versus 1.3%). The 30-day (9.6% versus 11.7%) and 180-day (24.6% versus 28.2%) readmission rates were significantly lower in the CPD cohort. Among patients who developed stroke, patients with a CPD had more frequent routine discharges. Prior valve surgery was associated with the highest risk of overall and major stroke.
Conclusions:
CPD use during transcatheter aortic valve replacement was not independently associated with a lower risk of overall stroke but was associated with a lower risk of major stroke in a multivariable model. Data from future randomized trials that may offset any potential confounders in our study are required to help identify patients who would benefit from the use of these devices.
