Early Outcomes With Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation
Background: Limited 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 wit...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-01-01
|
| Series: | Structural Heart |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2474870624001088 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1823861221937381376 |
|---|---|
| author | Shashank Shekhar, MD Amar Krishnaswamy, MD Grant Reed, MD, MSc James Yun, MD Rishi Puri, MD, PhD Samir Kapadia, MD |
| author_facet | Shashank Shekhar, MD Amar Krishnaswamy, MD Grant Reed, MD, MSc James Yun, MD Rishi Puri, MD, PhD Samir Kapadia, MD |
| author_sort | Shashank Shekhar, MD |
| collection | DOAJ |
| description | Background: Limited 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). Methods: Data 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. Results: Of 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. Conclusions: The 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. |
| format | Article |
| id | doaj-art-ead80ab21b304873be365d19ae87708b |
| institution | Kabale University |
| issn | 2474-8706 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Structural Heart |
| spelling | doaj-art-ead80ab21b304873be365d19ae87708b2025-02-10T04:34:41ZengElsevierStructural Heart2474-87062025-01-0191100353Early Outcomes With Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement in Patients With Atrial FibrillationShashank Shekhar, MD0Amar Krishnaswamy, MD1Grant Reed, MD, MSc2James Yun, MD3Rishi Puri, MD, PhD4Samir Kapadia, MD5Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OhioDepartment of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OhioDepartment of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OhioDepartment of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OhioDepartment of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OhioAddress correspondence to: Samir R. Kapadia, MD, FACC, FAHA, Chair, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195.; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OhioBackground: Limited 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). Methods: Data 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. Results: Of 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. Conclusions: The 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.http://www.sciencedirect.com/science/article/pii/S2474870624001088Cerebral embolic protectionMortalitySentinelStrokeTranscatheter aortic valve replacement |
| spellingShingle | Shashank Shekhar, MD Amar Krishnaswamy, MD Grant Reed, MD, MSc James Yun, MD Rishi Puri, MD, PhD Samir Kapadia, MD Early Outcomes With Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation Structural Heart Cerebral embolic protection Mortality Sentinel Stroke Transcatheter aortic valve replacement |
| title | Early Outcomes With Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation |
| title_full | Early Outcomes With Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation |
| title_fullStr | Early Outcomes With Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation |
| title_full_unstemmed | Early Outcomes With Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation |
| title_short | Early Outcomes With Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation |
| title_sort | early outcomes with cerebral embolic protection during transcatheter aortic valve replacement in patients with atrial fibrillation |
| topic | Cerebral embolic protection Mortality Sentinel Stroke Transcatheter aortic valve replacement |
| url | http://www.sciencedirect.com/science/article/pii/S2474870624001088 |
| work_keys_str_mv | AT shashankshekharmd earlyoutcomeswithcerebralembolicprotectionduringtranscatheteraorticvalvereplacementinpatientswithatrialfibrillation AT amarkrishnaswamymd earlyoutcomeswithcerebralembolicprotectionduringtranscatheteraorticvalvereplacementinpatientswithatrialfibrillation AT grantreedmdmsc earlyoutcomeswithcerebralembolicprotectionduringtranscatheteraorticvalvereplacementinpatientswithatrialfibrillation AT jamesyunmd earlyoutcomeswithcerebralembolicprotectionduringtranscatheteraorticvalvereplacementinpatientswithatrialfibrillation AT rishipurimdphd earlyoutcomeswithcerebralembolicprotectionduringtranscatheteraorticvalvereplacementinpatientswithatrialfibrillation AT samirkapadiamd earlyoutcomeswithcerebralembolicprotectionduringtranscatheteraorticvalvereplacementinpatientswithatrialfibrillation |