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Safety and efficacy of cerebral embolic protection devices in patients undergoing transcatheter aortic valve replacement: a meta-analysis of in-hospital outcomes

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Abstract

The evidence regarding the impact of cerebral embolic protection devices (EPDs) on outcomes following transcatheter aortic valve replacement (TAVR) is limited. The objective of this study was to evaluate in-hospital outcomes with the use of cerebral EPDs in TAVR. We performed a comprehensive EMBASE and PUBMED search to investigate randomized control studies or propensity score-matched retrospective studies which assessed patients undergoing TAVR with or without EPD up to April 2021. Endpoints of interest were in-hospital mortality, stroke, acute kidney injury, pacemaker implantation, major bleeding, vascular complication, length of stay. Ten studies involving 173,002 patients with EPD (n = 16,898, 9.8%) and those without (n = 156,104, 90.2%) fulfilled the inclusion criteria. The use of EPD was associated with significantly lower risk of in-hospital stroke (odds ratio [95% confidential interval]: 0.64 [0.46; 0.89]), but similar rate of in-hospital mortality (odds ratio [95% confidential interval]: 0.75 [0.54; 1.05]). No differences were observed in acute kidney injury, pacemaker implantation, major bleeding, vascular complication, length of stay. EPD during TAVR was associated with lower in-hospital stroke but did not affect procedural complications and length of stay.

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Authors and Affiliations

  1. Division of Cardiac Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Junichi Shimamura

  2. Department of Cardiology, Montefiore Medical Center, Albert Einstein Medical College, Bronx, NY, USA

    Toshiki Kuno

  3. Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA

    Aaqib Malik

  4. Department of Surgery, Easton Hospital, Easton, PA, USA

    Yujiro Yokoyama

  5. Department of Cardiology, Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA, USA

    Rahul Gupta

  6. Division of Cardiology, Westchester Medical Center, Valhalla, NY, USA

    Hasan Ahmad

  7. Section of Heart Failure and Transplant, Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52242, USA

    Alexandros Briasoulis

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  1. Junichi Shimamura
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  2. Toshiki Kuno
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Correspondence to Alexandros Briasoulis.

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Shimamura, J., Kuno, T., Malik, A. et al. Safety and efficacy of cerebral embolic protection devices in patients undergoing transcatheter aortic valve replacement: a meta-analysis of in-hospital outcomes. Cardiovasc Interv and Ther 37, 549–557 (2022). https://doi.org/10.1007/s12928-021-00823-1

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  • DOI: https://doi.org/10.1007/s12928-021-00823-1

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