Early Outcomes With Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation

Highlights•Stroke remains a formidable cause of morbidity, mortality, and resource utilization in transcatheter aortic valve replacement (TAVR) patients.•Sentinel cerebral embolic protection device (CPD) is designed to capture and remove debris thereby reducing the risk of stroke.•There is an interest in identifying patients who may benefit from the use of the CPD.•Patients with atrial fibrillation undergoing TAVR with CPD had lower overall stroke, and major stroke.•Thirty-day all cause readmissions were lower in patients with atrial fibrillation undergoing TAVR with CPD use.•Future studies from other registries and clinical trials are required to corroborate our findings and to identify candidates for CPD use.AbstractBackgroundLimited studies are available which aim to identify patient populations that would potentially benefit from the use of cerebral embolic protection devices (CPDs) during transcatheter aortic valve replacement (TAVR). We aimed to analyze the impact of CPD use during TAVR among patients with atrial fibrillation (AF).MethodsData on adult TAVR patients with a concomitant diagnosis of AF was obtained from the 2017-2020 National Readmissions Database. Stroke, major stroke, in-hospital mortality, and 30-day readmission rates were compared between the CPD and no-CPD cohorts in a propensity score matched analysis. Association of CPD use with adverse events was analyzed using multivariable logistic regression models.ResultsOf 100,928 eligible TAVR patients with AF, CPD was used in 6.9% of patients with a mean age of 80 years. CPD use was independently associated with lower overall stroke (1.7% vs. 2.2%; odds ratio OR 0.81 95% CI 0.68-0.98; p = 0.032), major stroke (1.2% vs. 1.8%; OR 0.69 0.55-0.86; p = 0.001), in-hospital mortality (0.9 vs. 1.5%; OR 0.56 0.43-0.72; p < 0.001), and lower 30-day readmission rates (12.7% vs. 14.7%; OR 0.87 0.81-0.94; p < 0.001). Reduction in adverse events with CPD was noted in high-volume but not in low-volume TAVR centers.ConclusionsThe present point towards clear benefits of CPD use among patients with AF undergoing TAVR. In anatomically eligible patients, the potential benefit of debris capture may be considered especially as younger and lower risk patients become eligible for TAVR. Data from future trials and registries are required to further corroborate our findings.