JTCVS structural and endovascular · 2025
Outcome of cerebral embolic protection during transcatheter aortic valve replacement in high-risk patient for stroke.
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Nakai Chikashi, Liu Junyi, Azhagiri Nikhil, Ku Andrew, Wu Yuan Haw, Danduch Eduardo, Tarabichi Saeed, DeLago Augustin
Аннотация
OBJECTIVES: The sentinel cerebral embolic protection device has been used as prophylaxis of stroke and transient ischemic attack during transcatheter aortic valve replacement. However, there are no absolute criteria guiding cerebral embolic protection device placement. This study aimed to evaluate the impact of cerebral embolic protection on postoperative cerebrovascular events in patients at high risk for stroke.
METHODS: Between April 2021 and August 2023, 695 patients underwent transcatheter aortic valve replacement through a transfemoral approach. The cerebral embolic protection device was placed at the beginning of transcatheter aortic valve replacement procedure when 1 of the following criteria was met preoperatively: bicuspid aortic valve, valve-in-valve procedure, or calcium score in computed tomography greater than 1000. Of 695 patients with transcatheter aortic valve replacement, 636 met the criteria. The cerebral embolic protection device was placed in 55% of patients (350/636, cerebral embolic protection group) and not placed in 45% of patients (286/636, non-cerebral embolic protection group) because cerebral embolic protection was not feasible anatomically. A 1:1 propensity score matching was performed using the nearest neighbor method between cerebral embolic protection and non-cerebral embolic protection groups.
RESULTS: A total of 245 pairs were matched in propensity score matching. After matching, postoperative stroke/transient ischemic attack occurred in 0.4% (1/245) in the cerebral embolic protection group and 2.9% (7/245) in the non-cerebral embolic protection group. A significant difference was noted in postoperative stroke/transient ischemic attack between the 2 groups (P = .03). Early mortality and other complications did not differ between the 2 groups. In postoperative follow-up, incidence of stroke/transient ischemic attack was similar in 30 days (2.0% vs 1.2%, P = .72) and 1 year (0.4% vs 1.2%, P = .62). There was no vascular complication at the cerebral embolic protection access site.
CONCLUSIONS: Cerebral embolic protection during transcatheter aortic valve replacement might reduce postoperative cerebrovascular events in patients who are high risk for stroke in this patient cohort.
METHODS: Between April 2021 and August 2023, 695 patients underwent transcatheter aortic valve replacement through a transfemoral approach. The cerebral embolic protection device was placed at the beginning of transcatheter aortic valve replacement procedure when 1 of the following criteria was met preoperatively: bicuspid aortic valve, valve-in-valve procedure, or calcium score in computed tomography greater than 1000. Of 695 patients with transcatheter aortic valve replacement, 636 met the criteria. The cerebral embolic protection device was placed in 55% of patients (350/636, cerebral embolic protection group) and not placed in 45% of patients (286/636, non-cerebral embolic protection group) because cerebral embolic protection was not feasible anatomically. A 1:1 propensity score matching was performed using the nearest neighbor method between cerebral embolic protection and non-cerebral embolic protection groups.
RESULTS: A total of 245 pairs were matched in propensity score matching. After matching, postoperative stroke/transient ischemic attack occurred in 0.4% (1/245) in the cerebral embolic protection group and 2.9% (7/245) in the non-cerebral embolic protection group. A significant difference was noted in postoperative stroke/transient ischemic attack between the 2 groups (P = .03). Early mortality and other complications did not differ between the 2 groups. In postoperative follow-up, incidence of stroke/transient ischemic attack was similar in 30 days (2.0% vs 1.2%, P = .72) and 1 year (0.4% vs 1.2%, P = .62). There was no vascular complication at the cerebral embolic protection access site.
CONCLUSIONS: Cerebral embolic protection during transcatheter aortic valve replacement might reduce postoperative cerebrovascular events in patients who are high risk for stroke in this patient cohort.