Clinical impact of cerebral protection during transcatheter aortic valve implantation
Background Embolization of debris can complicate transcatheter aortic valve implantation (TAVI) causing stroke. Cerebral embolism protection (CEP) devices can divert or trap debris. Purpose To evaluate the efficacy of CEP during TAVI vs the standard procedure. Data Sources PubMed, SCOPUS and DOAJ 1/...
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Published in | European journal of clinical investigation Vol. 54; no. 5; pp. e14166 - n/a |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
England
Blackwell Publishing Ltd
01.05.2024
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Subjects | |
Online Access | Get full text |
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Summary: | Background
Embolization of debris can complicate transcatheter aortic valve implantation (TAVI) causing stroke. Cerebral embolism protection (CEP) devices can divert or trap debris.
Purpose
To evaluate the efficacy of CEP during TAVI vs the standard procedure.
Data Sources
PubMed, SCOPUS and DOAJ 1/01/2014–04/12/2023.
Study Selection
Randomized and observational studies comparing CEP versus standard TAVI, according to PRISMA. Primary outcome: stroke. Secondary outcomes: death, bleeding, vascular access complications, acute kidney injury and infarct area.
Data Extraction
Two investigators independently assessed study quality and extracted data.
Data Synthesis
Twenty‐six articles were included (540.247 patients). The primary endpoint was significantly lower (RR = 0.800 95%CI:0.682–0.940; p = 0.007) with CEP. Similarly, death rates were significantly lower with CEP (RR = 0.610 95%CI:0.482–0.771; p < 0.001). No difference was found for bleeding (RR = 1.053 95%CI:0.793–1.398; p = 0.721), vascular complications (RR = 0.937 95%CI:0.820–1.070; p = 0.334) or AKI (RR = 0.982 95%CI:0.754–1.279; p = 0.891).
Conclusions
Use of CEP during TAVI is associated with improved outcomes. Future studies will identify patients who benefit most from CEP.
Embolization of debris can complicate transcatheter aortic valve implantation (TAVI), eventually leading to stroke. The aim of our meta‐analysis was to evaluate the efficacy of cerebral embolism protection (CEP) devices during TAVI. The primary outcome was post‐procedural stroke. Secondary outcomes: death, bleeding, vascular access complication, acute kidney injury (AKI) and infarct area. Use of CEP during TAVI is associated with a significantly lower rate of stroke and death, without a significant increase in AKI, bleeding or vascular access complications. |
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Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1 |
ISSN: | 0014-2972 1365-2362 |
DOI: | 10.1111/eci.14166 |