Background: Cerebral embolic protection (CEP) reduces strokes during transcatheter aortic valve replacement (TAVR), but is not standard-of-care at most centers.
Aims: To assess 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.
Results: Non-CEP patients had significantly higher Society of Thoracic Surgeon’s 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 {IQR: 46.0-66.0}, vs. 53.0 {43.0-63.3} minutes, 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 (0.6 vs. 0.4%, p=0.63), in-hospital disabling stroke occurred more often in non-CEP patients (4.0 vs. 1.8%, 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.
