Clinical research in cardiology : official journal of the German Cardiac Society · 2025
Cerebral embolic protection (CEP) during transcatheter aortic valve replacement (TAVR) is associated with a lower rate of stroke at a high-volume center.
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Paukovitsch Michael, Lorenz Julia, Felbel Dominik, Scheffler Jinny, Krohn-Grimberghe Marvin, Schneider Leonhard Moritz, Mörike Johannes, Rottbauer Wolfgang, Buckert Dominik
Аннотация
BACKGROUND: Cerebral embolic protection (CEP) reduces strokes during transcatheter aortic valve replacement (TAVR) but is not standard of care at most centers.
AIM: To assess the impact of CEP use in real-world practice at a tertiary center using CEP as a standard of care during TAVR.
METHODS: In-hospital outcome of 2173 patients was compared to 328 (13.1%) patients who could not receive CEP during TAVR due to anatomical or technical reasons. In a secondary analysis, adjusted stroke risk was compared using propensity score matching.
RESULTS: Non-CEP patients had significantly higher Society of Thoracic Surgeons score for mortality (5.2 [interquartile range (IQR): 3.3-7.9] vs. 3.4% [IQR: 2.2-5.9], p < 0.01) and were more often female (54.0 vs. 46.4%, p = 0.01). Comorbidities such as coronary artery disease (63.4 vs. 61.7%, p = 0.54) and prior cardiac surgery (11.9 vs. 9.6%, p = 0.19) were equally frequent in both groups, whereas a history of prior stroke (16.2 vs. 11.7%, p = 0.02) was more frequent in non-CEP patients. Despite significantly longer procedure time in CEP patients (55.0 min [IQR: 46.0-66.0] vs. 53.0 min [43.0-63.3], p < 0.01), intraprocedural death (0 vs. 0.1%, p = 1.0), arrhythmia (11.9 vs. 11.9%, p = 0.99), and vascular access-site complications (5.5 vs. 4.3%, p = 0.32) were equally frequent. Although intraprocedural stroke occurred seldomly in both patient groups (0 vs. 0.3%, p = 1.0), in-hospital disabling stroke occurred more often in non-CEP patients (4.0 vs. 1.8%, p = 0.01). In the propensity score matched cohort, CEP use was associated with a significantly lower risk of all stroke (OR: 0.41, 95% CI: 0.22-0.77, p < 0.01) as well as disabling stroke (OR: 0.37, 95% CI: 0.18-0.78, p < 0.01).
CONCLUSION: At a high-volume center using CEP as part of its standard of care during TAVR, CEP use was associated with a lower rate of in-hospital stroke. Especially those patients who could not receive CEP seemed to be at increased risk for stroke.
AIM: To assess the impact of CEP use in real-world practice at a tertiary center using CEP as a standard of care during TAVR.
METHODS: In-hospital outcome of 2173 patients was compared to 328 (13.1%) patients who could not receive CEP during TAVR due to anatomical or technical reasons. In a secondary analysis, adjusted stroke risk was compared using propensity score matching.
RESULTS: Non-CEP patients had significantly higher Society of Thoracic Surgeons score for mortality (5.2 [interquartile range (IQR): 3.3-7.9] vs. 3.4% [IQR: 2.2-5.9], p < 0.01) and were more often female (54.0 vs. 46.4%, p = 0.01). Comorbidities such as coronary artery disease (63.4 vs. 61.7%, p = 0.54) and prior cardiac surgery (11.9 vs. 9.6%, p = 0.19) were equally frequent in both groups, whereas a history of prior stroke (16.2 vs. 11.7%, p = 0.02) was more frequent in non-CEP patients. Despite significantly longer procedure time in CEP patients (55.0 min [IQR: 46.0-66.0] vs. 53.0 min [43.0-63.3], p < 0.01), intraprocedural death (0 vs. 0.1%, p = 1.0), arrhythmia (11.9 vs. 11.9%, p = 0.99), and vascular access-site complications (5.5 vs. 4.3%, p = 0.32) were equally frequent. Although intraprocedural stroke occurred seldomly in both patient groups (0 vs. 0.3%, p = 1.0), in-hospital disabling stroke occurred more often in non-CEP patients (4.0 vs. 1.8%, p = 0.01). In the propensity score matched cohort, CEP use was associated with a significantly lower risk of all stroke (OR: 0.41, 95% CI: 0.22-0.77, p < 0.01) as well as disabling stroke (OR: 0.37, 95% CI: 0.18-0.78, p < 0.01).
CONCLUSION: At a high-volume center using CEP as part of its standard of care during TAVR, CEP use was associated with a lower rate of in-hospital stroke. Especially those patients who could not receive CEP seemed to be at increased risk for stroke.