The Role of Cerebral Embolic Protection Devices During Transcatheter Aortic Valve Replacement.

Ozan M Demir,Azeem Latib,Gianmarco Iannopollo,Damiano Regazzoli,Marco B Ancona,Giora Weisz,Antonio Colombo,Satoru Mitomo,Antonio Mangieri

doi:10.3389/fcvm.2018.00150

Abstract

Transcatheter aortic valve replacement is the therapy of choice for patients with severe aortic stenosis who have prohibitive or high surgical risk. However, the benefit of TAVR is attenuated by the occurrence of major disabling stroke which is associated with increased mortality and early-reduced quality of life. Despite advances in TAVR technology, stroke remains a serious complication that is associated with significant negative outcomes. The majority of these occur in the acute phase following TAVR where cerebral embolic events are frequent. Cerebral embolic protection devices (CEPD) have been developed to minimize the risk of peri-procedural ischemic stroke during TAVR. CEPD have the potential to reduce intraprocedural burden of new silent ischemic injury. In this review we outline the etiology and incidence of stroke in TAVR population, and systematically review current evidence for cerebral embolic protection devices.

Highlights

Aortic stenosis (AS) is the most common valvular pathology in the elderly and its prevalence is expected to increase rapidly over the decade due to an aging population [1, 2]
The benefit of Transcatheter aortic valve replacement (TAVR) is attenuated by the occurrence of major disabling stroke which is associated with increased mortality and in the short term reduced quality of life
The PROTAVI-C study demonstrated that Embolic Deflector device (EED) use during TAVR is feasible and safe with minimal procedural complications related to the device (1 radial thrombosis with no clinical consequences and 1 pseudoaneurysm of the brachial artery that required surgical repair)

Summary

INTRODUCTION

Aortic stenosis (AS) is the most common valvular pathology in the elderly and its prevalence is expected to increase rapidly over the decade due to an aging population [1, 2]. The incidence of subclinical new cerebral ischemic lesions has been identified in as many as 93% of patients post-TAVR and recent pooled analysis reported an incidence of 77.5% [25] These are up to double of that seen in isolated surgical aortic valve replacement [26]. The PROTAVI-C study demonstrated that EED use during TAVR is feasible and safe with minimal procedural complications related to the device (1 radial thrombosis with no clinical consequences and 1 pseudoaneurysm of the brachial artery that required surgical repair). The CLEAN TAVI study [43] was a single center, blinded, randomized clinical trial that evaluated the efficacy of the Claret device in reducing the number of cerebral lesions in patients undergoing TAVR with Medtronic CoreValve. Oval shaped nitinol frame (length 59 mm, width 25.5 mm) Covered with a porus polyurethane membrane Pore size: 100 μm Radial/brachial artery

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CONCLUSION

DISCUSSION