Abstract
Aortic valve stenosis is one of the most common valvular abnormalities, which can manifest as angina, syncope, dyspnoea and sudden cardiac death. Transcatheter aortic valve implantation (TAVI) has been introduced as an alternative to surgical valve replacement in patients with severe aortic valve stenosis, resulting in less morbidity, shorter time to recovery and similar mortality rates. Progress in this field has reduced complication rates. However, the incidence of peri-procedural stroke remains relatively high (around 4%). To fully utilise the potential of TAVI, cerebral embolic protection devices (CEPD) have been developed and introduced. In this position paper, we aim to summarise the available data on several CEPD.
Highlights
Since the introduction of transcatheter aortic valve implantation (TAVI) in 2002, the procedure has become an attractive alternative to surgical valve replacement in the treatment of severe aortic valve stenosis
Randomised studies did not demonstrate the superiority of cerebral embolic protection devices (CEPD) during TAVI procedures for hard clinical endpoints, most likely because these studies were not powered for hard clinical endpoints such as the occurrence of stroke
Avoiding stroke by the use of CEPD during TAVI is emerging as an important tool to reduce the burden of neurocognitive decline post-procedure
Summary
Since the introduction of transcatheter aortic valve implantation (TAVI) in 2002, the procedure has become an attractive alternative to surgical valve replacement in the treatment of severe aortic valve stenosis. Determining high-intensity transient signals (HITS) by transcranial Doppler (TCD) measurements during TAVI, which represents solid or gaseous cerebral micro-emboli passing through the middle cerebral artery, could become an important tool in the detection of these emboli, because it has the ability to provide real-time data on blood filtration with a CEPD and provide insights into the critical phases of the TAVI procedure, such as valve positioning, balloon valvuloplasty and deployment of the prosthesis. In this position paper, we aim to summarise the available data on several CEPD
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