Author + information
- Tobias Schmidt1,
- Ozan Akdag2,
- Peter Wohlmuth3,
- Thomas Thielsen4,
- Dimitry Schewel5,
- Hannes Alessandrini6,
- Felix Kreidel7,
- Ralf Bader8,
- Maria Romero9,
- Elena Ladich10,
- Renu Virmani11,
- Ulrich Schaefer12,
- Karl-Heinz Kuck13 and
- Christian Frerker14
- 1Asklepios Klinik St. Georg, Hamburg, Germany
- 3Royal Stoke University Hospital
- 4Asklepios Klinik St. Georg, Hamburg, Germany
- 5Asklepios Clinic St. Georg, Hamburg, Germany
- 6National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
- 7Asklepios Klinik St. Georg, Hamburg, Germany
- 8Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus, Essen, Germany, Hamburg, Germany
- 9Duke Clinical Research Institute
- 10CVPath Institute, Inc., Gaithersburg, Maryland, United States
- 11CVPath Institute, Inc., Gaithersburg, Maryland, United States
- 12National Taiwan University Hospital, Taipei, Taiwan
- 13Asklepios Hospital St. Georg, Hamburg, Germany
- 14Asklepiosklinikum St. Georg, Hamburg, Germany
Histopathologic analyses of debris captured by a cerebral protection system (CPS) during transcatheter aortic valve replacement (TAVR) have been reported but it was not possible to determine the origin of the debris nor to define risk factors.
Embolic debris captured in 322 filters of a dual-cerebral filter protection system from 161 patients (age 81 years, 82 male patients (51%), logistic EuroSCORE 19% [Interquartile range 12–31]), after TAVR was analyzed.
Debris capture rate was high with 97% of all patients (156/161). No differences according to the filter location were found (brachiocephalic trunk: 86% [139/161], left carotid artery: 91% [147/161]; 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 (Odds ratio (OR) 0.733, confidence interval (CI) 0.552, 0.969), and diabetes (OR 1.474, CI 1.089, 2.001), were significant risk factors for embolic debris. Additional analysis showed significantly more valve tissue in patients with pre-dilation (p=0.0294). Stroke and transient ischemic attack rate was 0.6% each (1/161).
High embolic debris capture rates, consisting of tissue from typical anatomical structures known to be altered in patients with aortic stenosis undergoing TAVR, can be demonstrated. Female patients with diabetes have an increased risk of generating embolic debris, and should be protected by a cerebral protection system during TAVR. Since valve tissue embolizes in patients with pre-dilation more often, procedure planning should consider this finding. Both cerebral arteries (brachiocephalic trunk, left carotid artery) should be protected in the same way.
STRUCTURAL: Valvular Disease: Aortic