Abstract 10037: Cerebral Embolic Protection During Transcatheter Aortic Valve Implantation: Updated Systemic Review and Meta-Analysis

Abstract

Introduction: In patient undergoing transcatheter aortic valve implantation (TAVI), stroke remains a potentially devastating complication associated with significant morbidity and mortality. Hypothesis: To reduce the risk of stroke, cerebral protection devices (CPD) were developed to prevent debris from embolizing to the brain during TAVI.The data on the safety and efficacy of cerebral protection devices (CPD) remains limited. Methods: 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). Results: Using a pooled analysis, CPD was associated with a significant reduction in major adverse cardiovascular events (MACE) (OR 0.69, 95% CI 0.50-0.96, p=0.03) and stroke (OR 0.61, 95% CI 0.42-0.90, p=0.08) in patients undergoing TAVI. Similarly, on MRI volume per lesion were lower for patients with CPD use (SMD -0.79 [-1.30,-0.28], p<0.01). No significant difference were observed in mortality (OR 0.97, 95% CI 0.60-1.55, p=0.88), acute kidney injury (OR 0.75, 95% CI 0.42-1.37, p=0.68), bleeding (OR 0.93, 95% CI 0.52-1.65, p=0.80) or vascular complications (OR 0.90, 95% CI 0.62-1.31, p=0.6) for patients undergoing TAVI with CPD. Conclusions: In conclusion, CPD device use in TAVI is associated with a reduction of MACE and stroke compared with patients undergoing TAVI without CPD.