Stroke remains a serious complication of transcatheter aortic valve implantation (TAVI).
Prior studies examining the association between cerebral embolic protection device
(CEPD) use and stroke following TAVI have produced conflicting results. We used the
Nationwide Readmissions Databases to identify all percutaneous (non-transapical) TAVIs
performed in the US from July, 2017 to December, 2018. Overlap propensity score weighted
logistic regression models were used to determine the association between CEPD use
and outcomes. The primary outcome was in-hospital stroke or transient ischemic attack
(TIA). Among 50,000 percutaneous TAVIs (weighted national estimate: 88,886 [SE: 2,819]),
CEPD was used in 2,433 (weighted national estimate: 3,497 [SE: 857]). Nationally,
the utilization rate of CEPD was 3.9% (SE: 0.9%) of all TAVIs during the overall study
period, which increased from 0.8% (SE: 0.4%) in 2017Q3 to 7.6% (SE: 1.6%) in 2018Q4
(p<0.001). The proportion of hospitals using CEPD increased from 2.3% in 2017Q3 to
14.7% in 2018Q4 (p<0.001). There were no significant differences in rates of in-hospital
stroke/TIA in TAVIs with versus without CEPD (2.6% vs 2.2%; unadjusted OR [95% CI]
1.18 [0.98-1.52]; overlap propensity score weighted OR [95% CI] 1.19 [0.81-1.75]).
CEPD use was not associated with statistically significant lower rates of in-hospital
stroke, ischemic stroke, hemorrhagic stroke, TIA, all-cause mortality, or discharge
to skilled nursing facility. In conclusion, the rates of CEPD utilization and proportion
of TAVI hospitals using CEPD increased during the study period. The use of CEPD during
TAVI was not associated with statistically significant lower rates of in-hospital
stroke, TIA, or mortality.
Graphical abstract
Graphical Abstract
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Article info
Publication history
Published online: June 17, 2021
Received in revised form:
April 15,
2021
Received:
March 2,
2021
Footnotes
Source of Funding: None
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