Clinical impact of cerebral protection during transcatheter aortic valve implantation

Abstract

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.

Keywords: cerebral; debris; embolic; protection; stroke; TAVI.