Cerebral Protection Devices during TAVR in the Daily Practice

The theory behind the use of cerebral protection devices during TAVR is good, but hard to test. The daily practice provides a far bigger number of patients, and therefore might be able to better show how to prevent one of the hardest events during TAVR. 

La protección cerebral en TAVI continúa con evidencia débil pero con esperanzas

This study resorted to Germany’s TAVR database between 2015 and 2017, with over 40,000 patients, and looked into patients who had received a cerebral protection device during procedure. 

Cerebral protection devices were used only in 3.8% of patients who were younger, compared against the rest, but had higher surgical risk.

Propensity score was used to compare patients receiving cerebral protection devices vs. patients not receiving any. 

After adjusting, it was observed that the use of a cerebral protection device will not reduce the risk of stroke (p=0.069) or delirium after procedure (p=0.106). Delirium is interpreted as a sign of acute cerebral compromise. 


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What is curious is that even though researchers were no able to prevent stroke, they did see a drop in inhospital mortality with the use of protection devices (p=0.034). This reduction in mortality is difficult to explain from the physiopathological point of view and calls for further research. 

Conclusion

In this huge database, we observe that the use of cerebral protection devices during TAVR is fairly infrequent in the daily practice. Cerebral protection devices did not reduce the risk of stroke or delirium. 

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Original Title: The Use and Outcomes of Cerebral Protection Devices for Patients Undergoing Transfemoral Transcatheter Aortic Valve Replacement in Clinical Practice.

Reference: Peter Stachon et al. J Am Coll Cardiol Intv 2021;14:161–8. https://doi.org/10.1016/j.jcin.2020.09.047.


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