Use of Cerebral Embolic Protection Devices in Transcatheter Aortic Valve Replacement, From National Inpatient Sample
Presenter
Salman Zahid, Rochester General Hospital, Rochester, NY
Salman Zahid1, Muhammad Z Khan, MD2, Muhammad U Khan3 and Sudarshan Balla, MD2, (1)Rochester General Hospital, Rochester, NY, (2)West Virginia University School Of Medicine, Morgantown, WV, (3)The West Virginia University School of Medicine, Morgantown, WV
Keywords: TAVI/TAVR/Aortic Valve
Background
Outcome data on use of cerebral embolic protection device (CPD) with transcatheter aortic valve replacement (TAVR) remains limited. Previous randomized trials have largely remained underpowered for primary outcomes of stroke prevention and mortality.
Methods
The National Inpatient Sample (NIS) database from 2017 to 2018 was queried to study the utilization, mortality, neurological complications (ischemic stroke, hemorrhagic stroke and Transient ischemic attack), complications and resource utilization, with and without use of CPD. A 1:3 ratio balanced propensity match model was created.
Results
Among 108,315 patients who underwent TAVR, CPD was used in 4,380 patients (4.0%). Adjusted mortality was lower in patients undergoing TAVR with CPD (1.3% vs 0.5%, p<0.01). Neurological complications (2.5% vs 1.7%, p<0.01), hemorrhagic stroke (0.2% vs 0%, p<0.01) and ischemic stroke (2.2% vs 1.4%, p<0.01) were also lower in TAVR with CPD. Multiple logistic regression showed CPD use was associated with lower adjusted mortality (odds ratio [OR], 0.34 [95% confidence interval [CI], 0.22-0.52], p<0.01) and lower adjusted neurological complications (OR, 0.68 [95% CI, 0.54-0.85], p<0.01).
Conclusions
We report real word data on in-hospital outcomes of concurrent CPD device use in TAVR. Concomitant CPD use with TAVR is associated with lower mortality, lower neurological and clinical complications as compared to TAVR without CPD.
