Cerebral Embolic Protection during Transcatheter Aortic Valve Implantation: Updated Systematic Review and Meta-Analysis

被引:8
|
作者
Zahid, Salman [1 ]
Ullah, Waqas [2 ]
Khan, Muhammad Zia [3 ]
Uddin, Muhammad Faisal [1 ]
Rai, Devesh [1 ]
Abbas, Sakina [4 ]
Khan, Muhammad Usman [2 ]
Hussein, Ahmed [1 ]
Salama, Amr [1 ]
Bandyopadhyay, Dhrubajyoti [5 ]
Baibhav, Bipul [1 ]
Rao, Mohan [1 ]
Alam, Mahboob [6 ]
Alraies, M. Chadi [7 ]
Balla, Sudarshan [3 ]
Alkhouli, Mohamad [8 ]
Depta, Jeremiah P. [1 ]
机构
[1] Rochester Gen Hosp, Sands Constellat Heart Inst, Rochester, NY 14621 USA
[2] Thomas Jefferson Univ Hosp, Dept Cardiovasc Med, Philadelphia, PA USA
[3] West Virginia Univ, Heart & Vasc Inst, Div Cardiovasc Med, Morgantown, WV USA
[4] Dow Med Coll, Dept Med, Karachi, Pakistan
[5] New York Med Coll, Divi s Cardiovasc Med, Westchester Med Ctr, New York, NY USA
[6] Baylor Coll Med, Div Cardiol, Houston, TX USA
[7] Detroit Med Ctr, Div Cardiol, Detroit, MI USA
[8] Mayo Clin, Div Intervent Cardiol, Rochester, MN USA
关键词
REPLACEMENT; RISK; DEVICES; STROKE; SILENT; BRAIN; TAVI;
D O I
10.1016/j.cpcardiol.2022.101127
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
In patient undergoing transcatheter aortic valve implantation (TAVI), stroke remains a poten-tially devastating complication associated with signifi-cant morbidity, and mortality. To reduce the risk of stroke, cerebral protection devices (CPD) were devel-oped to prevent debris from embolizing to the brain during TAVI. We performed a systematic review and meta-analysis to determine the safety and efficacy of CPD in TAVI. The MEDLINE (PubMed, Ovid) and Cochrane databases were queried with various combi-nations of medical subject headings to identify relevant articles. Statistical analysis was performed using a random-effects model to calculate unadjusted odds ratio (OR), including subgroup analyses based on fol-low-up duration, study design, and type of CPD. Using a pooled analysis, CPD was associated with a signifi-cant reduction in major adverse cardiovascular events MACE (OR 0.75, 95% CI 0.70-0.81, P < 0.01), mortal-ity (OR 0.65, 95% CI 0.58-0.74, P < 0.01) and stroke (OR 0.84, 95% CI 0.76-0.93, P < 0.01) in patients undergoing TAVI. Similarly, on MRI volume per lesion were lower for patients with CPD use. No signifi-cant difference was observed in acute kidney injury (OR 0.75, 95% CI 0.42-1.37, P = 0.68), bleeding (OR 0.92, 95% CI 0.71-1.20, P = 0.55) or vascular complica-tions (OR 0.90, 95% CI 0.62-1.31, P = 0.6) for patients undergoing TAVI with CPD. In conclusion, CPD device use in TAVI is associated with a reduction of MACE, mortality, and stroke compared with patients undergoing TAVI without CPD. However, the signifi-cant reduction in mortality is driven mainly by obser-vational studies. (Curr Probl Cardiol 2023;48:101127.)
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页数:17
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