Clinical impact of cerebral protection during transcatheter aortic valve implantation.

Abstract

Embolization of debris can complicate transcatheter aortic valve implantation (TAVI) causing stroke. Cerebral embolism protection (CEP) devices can divert or trap debris. To evaluate the efficacy of CEP during TAVI vs the standard procedure. PubMed, SCOPUS and DOAJ 1/01/2014-04/12/2023. Randomized and observational studies comparing CEP versus standard TAVI, according to PRISMA. stroke. death, bleeding, vascular access complications, acute kidney injury and infarct area. Two investigators independently assessed study quality and extracted data. 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). Use of CEP during TAVI is associated with improved outcomes. Future studies will identify patients who benefit most from CEP.