Cerebral Embolic Protection during Transcatheter Aortic Valve Implantation: Updated Systematic Review and Meta-Analysis

Authors

Salman Zahid, Rochester Regional HealthFollow
Waqas Ullah, Department of Cardiovascular Medicine, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
Muhammad Zia Khan, Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA.
Muhammad Faisal Uddin, Rochester Regional Health
Devesh Rai, Rochester Regional HealthFollow
Sakina Abbas, Department of Medicine, Dow Medical College, Karachi, Pakistan.
Muhammad Usman Khan, Department of Cardiovascular Medicine, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
Ahmed Hussein, Rochester Regional HealthFollow
Amr Salama, Rochester Regional HealthFollow
Dhrubajyoti Bandyopadhyay, Division of Cardiovascular Medicine, Westchester Medical Center at New York Medical College, Valhalla, New York.
Bipul Baibhav, Rochester Regional HealthFollow
Mohan Rao, Rochester Regional HealthFollow
Mahboob Alam, Division of Cardiology, Baylor College of Medicine, Houston, TX.
Chadi Alraies, Division of Cardiology, Detroit Medical Center, Detroit, MI, USA.
Sudarshan Balla, Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA.
Mohamad Alkhouli, Division of Interventional Cardiology, Mayo Clinic, Rochester, MN, USA.
Jeremiah P. Depta, Rochester Regional HealthFollow

Department

Cardiology

Document Type

Article

Publication Title

Current Problems in Cardiology

Abstract

BACKGROUND: In patient undergoing transcatheter aortic valve implantation (TAVI), stroke remains a potentially devastating complication associated with significant morbidity and mortality. To reduce the risk of stroke, cerebral protection devices (CPD) were developed to prevent debris from embolizing to the brain during TAVI.

METHODS AND RESULTS: We performed a systemic review and meta-analysis to determine the safety and efficacy of CPD in TAVI. The MEDLINE (PubMed, Ovid) and Cochrane databases were queried with various combinations of medical subject headings to identify relevant articles. Statistical analysis was performed using a random-effects model to calculate unadjusted odds ratio (OR), including subgroup analyses based on follow-up duration, study design, and type of CPD. Using a pooled analysis, CPD was associated with a significant reduction in major adverse cardiovascular events MACE (OR 0.75, 95% CI 0.70-0.81, p< 0.01), mortality (OR 0.65, 95% CI 0.58-0.74, p< 0.01) and stroke (OR 0.84, 95% CI 0.76-0.93, p< 0.01) in patients undergoing TAVI. Similarly, on MRI volume per lesion were lower for patients with CPD use. No significant difference was observed in acute kidney injury (OR 0.75, 95% CI 0.42-1.37, p=0.68), bleeding (OR 0.92, 95% CI 0.71-1.20, p=0.55) or vascular complications (OR 0.90, 95% CI 0.62-1.31, p=0.6) for patients undergoing TAVI with CPD.

CONCLUSION: In conclusion, CPD device use in TAVI is associated with a reduction of MACE, mortality and stroke compared with patients undergoing TAVI without CPD. However, the significant reduction in mortality is driven mainly by observational studies.

First Page

101127

DOI

10.1016/j.cpcardiol.2022.101127

Volume

48

Issue

6

Publication Date

6-2023

Comments

Record updated with published article citation 2023-05-11 LB.

Published online ahead of print 2022-02-03.

PubMed ID

35124076

Recommended Citation

Zahid, S., Ullah, W., Zia Khan, M., Faisal Uddin, M., Rai, D., Abbas, S., Usman Khan, M., Hussein, A., Salama, A., Bandyopadhyay, D., Baibhav, B., Rao, M., Alam, M., Alraies, C., Balla, S., Alkhouli, M., & Depta, J. P. (2023). Cerebral Embolic Protection during Transcatheter Aortic Valve Implantation: Updated Systematic Review and Meta-Analysis. Current Problems in Cardiology, 48 (6), 101127. https://doi.org/10.1016/j.cpcardiol.2022.101127