Safety and efficacy of cerebral embolic protection systems in transcatheter aortic valve replacement: a systematic review and meta-analysis.

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Expert Review of Cardiovascular Therapy Pub Date : 2024-12-27 DOI:10.1080/14779072.2024.2445256

Mazhed Kheyrbek, Sam Alsabti, Shailesh Niroula, Ela Ahmad, Mustapha Choucair, Unnati Bhatia, Adam Wernette, Karan Chhabra, Kateryna Strubchevska, Ivan Hanson, Alexandra Halalau

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Abstract

Background: Stroke is a potential complication of Transcatheter Aortic Valve Replacement (TAVR). Recent trials evaluating Cerebral Embolic Protection Systems (CEPS) to reduce the incidence of stroke after TAVR have been conflicting.

Methods: Multiple databases were searched for studies comparing TAVR with or without CEPS and that reported on the primary outcome of periprocedural stroke. Two authors individually screened the titles, the abstracts and the full texts using Covidence. Risk of bias was assessed using Cochrane's ROB-2 and ROBINS-I tools.

Results: A total of 15 studies (3 randomized controlled trials, 7 national registries, and 5 cohort studies) met the eligibility criteria and were included in our review. CEPS was associated with lower rates of periprocedural stroke [OR 0.71 (95% CI 0.55, 0.93) p = 0.012], as well as lower rates of mortality [OR 0.60 (95% CI 0.49, 0.74) p < 0.001]. There was no significant difference between the two groups in the incidence of acute kidney injury [OR 0.91 (95% CI 0.82, 1.01) p = 0.087], major vascular complications [OR 0.97 (95% CI 0.83, 1.14) p = 0.734], and major life-threatening bleeding [OR 0.89 (95% CI 0.73, 1.07) p = 0.222].

Conclusions: Our findings suggest that the use of CEPS in TAVR is associated with a lower risk of periprocedural stroke and mortality.

Registration: The PROSPERO identification number is CRD42022374055.

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背景：中风是经导管主动脉瓣置换术（TAVR）的潜在并发症。最近评估脑栓塞保护系统（CEPS）以降低 TAVR 术后中风发生率的试验结果相互矛盾：方法：在多个数据库中搜索了比较有或无 CEPS 的 TAVR 的研究，这些研究报告了围手术期中风的主要结果。两位作者使用 Covidence 分别筛选了标题、摘要和全文。使用 Cochrane 的 ROB-2 和 ROBINS-I 工具评估了偏倚风险：结果：15 项研究（3 项随机对照试验、7 项国家登记和 5 项队列研究）符合资格标准，并纳入了我们的综述。CEPS 与较低的围手术期中风发生率[OR 0.71 (95% CI 0.55, 0.93)p = 0.012]以及较低的死亡率[OR 0.60 (95% CI 0.49, 0.74)p = 0.087]、主要血管并发症发生率和死亡率相关。087]、主要血管并发症[OR 0.97（95% CI 0.83，1.14）p = 0.734]和危及生命的主要出血[OR 0.89（95% CI 0.73，1.07）p = 0.222]：我们的研究结果表明，在 TAVR 中使用 CEPS 可降低围手术期卒中和死亡风险：PROSPERO标识号为CRD42022374055。

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来源期刊

Expert Review of Cardiovascular Therapy CARDIAC & CARDIOVASCULAR SYSTEMS-

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3.70

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0.00%

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期刊介绍： Expert Review of Cardiovascular Therapy (ISSN 1477-9072) provides expert reviews on the clinical applications of new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage includes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery. The Expert Review format is unique. Each review provides a complete overview of current thinking in a key area of research or clinical practice.