Author + information
- Rodrigo Bagur,
- Karla Solo,
- Luis Nombela-Franco,
- Chun Shing Kwok and
- Mamas Mamas
Background: Silent ischemic embolic lesions are common following transcatheter aortic valve implantation (TAVI). It has been speculated that the use of embolic protection devices (EPD) may reduce the occurrence of these embolic lesions. The aim of this meta-analysis is to study whether EPD use reduces silent ischemic and clinical cerebrovascular events associated with TAVI.
Methods: We conducted a comprehensive search of MEDLINE and EMBASE to identify studies that evaluated patients undergoing TAVI with or without EPD. Random-effects meta-analyses were performed to estimate the effect of EPD compared with no-EPD during TAVI using aggregate data.
Results: Fifteen studies involving 807 patients (621/186 with/without EPD) fulfilled the inclusion criteria. The EPD-delivery success rate was reported in all studies and was achieved in 94.5% of patients. Meta-analyses evaluating EPD versus without EPD strategies could not confirm or exclude any differences in terms of clinically evident stroke (RR: 0.84, 95%CI: 0.32-2.23, P=0.73) or 30-day mortality (RR: 0.52, 95%Cl: 0.14-1.87, P=0.31). There were no significant differences in number of patients with new-silent ischemic lesions (RR: 0.98, 95%CI: 0.89-1.07, P=0.60) or number of lesions per patient (SMD: -0.19, 95%CI: -0.92,0.54; P=0.61). The use of EPD was associated with a significantly smaller ischemic volume per lesion (SMD: -0.52, 95%CI: -0.85, -0.20; P=0.002) and smaller total volume of lesions (SMD: -0.36, 95%CI: -0.62, -0.09; P=0.008).
Conclusions: The use of EPD during TAVI may be associated with smaller volume of silent ischemic lesions and smaller total volume of silent ischemic lesions. However, EPD may not reduce the number of new-single, multiple or total number of lesions. Moreover, there was only very low quality of evidence showing no significant differences between patients undergoing TAVI with or without EPD with respect to clinically evident stroke and mortality. Further randomized and adequately-powered studies are needed to ascertain differences in patient-important outcomes before EPD should be incorporated into routine TAVI practice.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Interventional Cardiology: TAVR 3
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1243-186
- 2017 American College of Cardiology Foundation