Cerebral embolic protection (CEP) during transcatheter aortic valve replacement (TAVR) is associated with a lower rate of stroke at a high-volume center

Abstract Background Cerebral embolic protection (CEP) reduces strokes during transcatheter aortic valve replacement (TAVR) but is not standard of care at most centers. Aim To assess the impact of CEP use in real-world practice at a tertiary center using CEP as a standard of care during TAVR. Methods In-hospital outcome of 2173 patients was compared to 328 (13.1%) patients who could not receive CEP during TAVR due to anatomical or technical reasons. In a secondary analysis, adjusted stroke risk was compared using propensity score matching. Results Non-CEP patients had significantly higher Society of Thoracic Surgeons score for mortality (5.2 interquartile range (IQR): 3.3–7.9 vs. 3.4% IQR: 2.2–5.9, p < 0.01) and were more often female (54.0 vs. 46.4%, p = 0.01). Comorbidities such as coronary artery disease (63.4 vs. 61.7%, p = 0.54) and prior cardiac surgery (11.9 vs. 9.6%, p = 0.19) were equally frequent in both groups, whereas a history of prior stroke (16.2 vs. 11.7%, p = 0.02) was more frequent in non-CEP patients. Despite significantly longer procedure time in CEP patients (55.0 min IQR: 46.0–66.0 vs. 53.0 min 43.0–63.3, p < 0.01), intraprocedural death (0 vs. 0.1%, p = 1.0), arrhythmia (11.9 vs. 11.9%, p = 0.99), and vascular access-site complications (5.5 vs. 4.3%, p = 0.32) were equally frequent. Although intraprocedural stroke occurred seldomly in both patient groups (0 vs. 0.3%, p = 1.0), in-hospital disabling stroke occurred more often in non-CEP patients (4.0 vs. 1.8%, p = 0.01). In the propensity score matched cohort, CEP use was associated with a significantly lower risk of all stroke (OR: 0.41, 95% CI: 0.22–0.77, p < 0.01) as well as disabling stroke (OR: 0.37, 95% CI: 0.18–0.78, p < 0.01). Conclusion At a high-volume center using CEP as part of its standard of care during TAVR, CEP use was associated with a lower rate of in-hospital stroke. Especially those patients who could not receive CEP seemed to be at increased risk for stroke. Graphical Abstract Two thousand five hundred one patients were analyzed according to CEP use. CEP could be used in the majority of patients, whereas a minority (13.1%) of patients could not receive CEP for technical or anatomical reasons. Non-CEP patients had significantly higher procedural risk and experienced in-hospital stroke more often.