BackgroundHistopathological analyses of debris captured by a cerebral protection system during transcatheter aortic valve replacement have been reported, but the origin of the captured debris was not determined and risk factors were not defined.Methods and ResultsEmbolic debris was analyzed from 322 filters used in a dual‐cerebral‐filter protection system implemented during transcatheter aortic valve replacement for 161 patients (mean age 81 years, 82 male [51%], logistic EuroSCORE 19% [interquartile range 12–31%]). The debris capture rate was high, with debris from 97% of all patients (156 of 161). No differences by filter location were found (brachiocephalic trunk 86% [139 of 161], left carotid artery 91% [147 of 161]; adjusted P=0.999). Five prevalent types of debris were identified: thrombus (91%), arterial wall tissue (68%), valve tissue (53%), calcification (46%), and foreign material (30%). Female sex (P=0.0287, odds ratio 1.364, 95% CI 1.032–1.812) and diabetes mellitus (P=0.0116, odds ratio 1.474, 95% CI 1.089–2.001) were significant risk factors for embolic debris. Additional analysis showed significantly more valve tissue in patients with predilation (P=0.0294). Stroke and transient ischemic attack rates were 0.6% each (1 of 161).ConclusionThis study showed a high rate of embolic debris consisting of typical anatomic structures known to be altered in patients with aortic stenosis undergoing transcatheter aortic valve replacement. Female patients with diabetes mellitus have increased risk of embolic debris and should be protected by a cerebral protection system during transcatheter aortic valve replacement. Because valve tissue embolizes more often in patients with predilation, procedural planning should consider this finding. Both cerebral arteries (brachiocephalic trunk, left carotid artery) should be protected in the same way.

Transcatheter VIV procedures were associated with the release of particulate debris into the cerebral circulation in all patients. The type of debris suggests that debris originates predominantly from arterial and valvular passage of the THV.

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BACKGROUND Coronary artery disease (CAD) and degenerative aortic valve disease have similar causes and often coexist. Significance of CAD as a risk factor of transcatheter aortic valve implantation (TAVI) outcome is suggested, but remains uncertain. The aim of our study was to evaluate the importance of CAD assessed by SYNTAX score (SS) prior to TAVI in terms of outcome.METHODS Eight hundred ninety-seven consecutive patients who underwent TAVI in 5 participating centres between January 2009 and December 2015 were included in the study. Thirty-day follow-up was available in each patient. Pre-procedural angiograms were analysed in order to calculate SYNTAX score. Patients were divided into cohorts based on the cut-off values suggested by previous studies (SS¼0 vs SS>0; SS<¼9 vs SS>9, SS<¼22 vs SS>22). Significance of pre-procedural SYNTAX score was assessed by Cox regression proportional hazards analysis and comparison of Kaplan-Meier survival curves with log-rank test. RESULTSMedian SYNTAX score prior to TAVI was 0 (IQR: 6). There was no impact of SYNTAX score on 30-day survival in Cox regression analysis (SS¼0: hazard ratio [HR] 0.67, 95% confidence intervals [CI] 0.40-1.11, p¼0.12; SS>0: HR 1.49 [0.9-2.47], p¼0.12; SS>9: HR 1.09 [CI 0.54-2.22], p¼0.8; SS>22: HR 1.22 [CI 0.64-2.34], p¼NS; SS>22: HR 0.05 [CI 0-430], p¼0.51). Comparison of Kaplan-Meier 30-day survival curves demonstrated no influence of pre-TAVI SYNTAX score on death rate (survival compared with log-rank test -SS¼0 vs SS>0: 94.4% vs 91.6%, p¼0.12; SS9 vs SS>9: 93.2% vs 92.6%, p¼0.8; SS22 vs SS>22: 93% vs 100%, p¼0.33).CONCLUSION On the contrary to recent studies, we found no impact of pre-procedural SYNTAX score value on TAVI outcome. Even though significance of CAD is suggested, SYNTAX score does not seem to reflect the actual importance of CAD in terms of 30-day survival after TAVI.

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