Boccuto F, Carabetta N, Cacia MA, Kanagala SG, Panuccio G, Torella D, De Rosa S. Clinical impact of cerebral protection during transcatheter aortic valve implantation.
Eur J Clin Invest 2024;
54:e14166. [PMID:
38269600 DOI:
10.1111/eci.14166]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/12/2023] [Accepted: 12/23/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND
Embolization of debris can complicate transcatheter aortic valve implantation (TAVI) causing stroke. Cerebral embolism protection (CEP) devices can divert or trap debris.
PURPOSE
To evaluate the efficacy of CEP during TAVI vs the standard procedure.
DATA SOURCES
PubMed, SCOPUS and DOAJ 1/01/2014-04/12/2023.
STUDY SELECTION
Randomized and observational studies comparing CEP versus standard TAVI, according to PRISMA.
PRIMARY OUTCOME
stroke.
SECONDARY OUTCOMES
death, bleeding, vascular access complications, acute kidney injury and infarct area.
DATA EXTRACTION
Two investigators independently assessed study quality and extracted data.
DATA SYNTHESIS
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).
CONCLUSIONS
Use of CEP during TAVI is associated with improved outcomes. Future studies will identify patients who benefit most from CEP.
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