Outcome of cerebral embolic protection during transcatheter aortic valve replacement in high risk patients for stroke

Abstract Introduction In transcatheter aortic valve replacement (TAVR) procedure, postoperative cerebrovascular accident is one of critical complications. Sentinel cerebral embolic protection device (CEP) has been used as prophylaxis of stroke and transient ischemic attack (TIA). However, there is still controversy in the use of CEP and no absolute criteria regarding CEP placement. Methods Between April 2021 and August 2023, 695 patients underwent TAVR through transfemoral approach. CEP was placed through right radial artery at the beginning of TAVR procedure when one of following criteria was met preoperatively; bicuspid aortic valve, valve-in-valve procedure, calcium score more than 1000 in computer tomography. Of 695 patients who undergoing TAVR, 636 met the criteria. CEP was placed in 55% (350/636, CEP group), not placed in 45% (286/636, non-CEP group) because CEP was not feasible anatomically. 1:1 propensity score matching was performed using the nearest neighbor method between CEP group and non-CEP group. Postoperative outcomes were evaluated in the two groups. Results 245 pairs were matched in propensity score matching. In-hospital stroke/TIA after matching was 0.4% (1/245) in CEP group, 2.9% (7/245) in non-CEP group, respectively. A significant difference was noted in in-hospital stroke/TIA between the two groups (p=0.03). Early mortality, permanent pacemaker placement, new dialysis requirement, and vascular surgical intervention for TAVR sheath access site did not differ between the two groups. In postoperative follow-up, incidence of stroke/TIA was similar in 30days (2.0% vs 1.2%, p=0.72) and 1year (0.4% vs 1.2%, p=0.62). There was no vascular complication at CEP access site. Conclusion Cerebral embolic protection during transcatheter aortic valve replacement might decrease postoperative cerebrovascular events in high risk patients for stroke in this patient cohort.Figure1 Table1