Efficacy of Cerebral Embolic Protection Device During Transcatheter Aortic Valve Implantation: An Updated Meta-Analysis 

Abstract

Aims: Perioperative stroke remains a devastating complication after transcatheter aortic valve implantation (TAVI), using cerebral embolic protection device (CEPD) during TAVI may reduce stroke rate according to some studies. Therefore, we conducted this meta-analysis and may suggest whether CPED should be routinely used during TAVI. Methods and results: Studies were included which compared the outcome of stroke when with or without CEPD during TAVI, random controlled trials (RCTs) only, and followed up for at least 30 days. The primary end point was stroke. The risk of stroke at 30-days was no significantly difference in using CEPD during TAVI compared with control: RR 0.84, 95% CI 0.63 to 1.12, p = 0.23, I2=9%. Subgroup analysis was conducted according to the type of CEPD. There were no significantly differences neither using I&LCCA type nor TMCA type compared with control: RR 0.69, 95% CI 0.47 to 1.00, p = 0.05, I2=25%; RR 1.16, 95% CI 0.74 to 1.83, p = 0.51, I2=0%. Conclusions: In this meta-analysis, there was no significant evidence indicated CEPD can reduce the risk of stroke risk during TAVI. However, subgroup analysis of I&LCCA type group P=0.05, according to the basis of the 95% CI around this outcome, it is hard to rule out the efficacy of CEPD during TAVI. Maybe with large sample size, one valve type only, one outcome definition only, multicenter studies and extend the retention time of CEPD, the efficacy of CEPD would be proofed.

Advances in Clinical Cardiology 2022: A Summary of Key Clinical Trials

“…Another area of current contention is the use of cerebral embolic protection (CEP) to reduce risk of stroke. While current guidance does not mandate use, some operators use in high-risk cases [27]. Kaur et al conducted a meta-analysis of 1,016 patients (mean age 81.3 years) from several randomised trials (DEFLECT III, MIS-TRAL-C, CLEAN-TAVI, SENTINEL, and REFLECT I and II) evaluating the TriGuard (Keystone Heart) and Sentinel devices versus standard care.…”