Thorac cardiovasc Surg
DOI: 10.1055/s-0039-1688483
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Impact of a Two-Filter Cerebral Embolic Protection Device on the Complexity and Risk of Transcatheter Aortic Valve Replacement

1  Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
2  Department of Cardiovascular Surgery, Institute of Translational Cardiac Surgery (Insure), German Heart Center Munich, Technische Universität München, Munich, Germany
,
Marcus-André Deutsch
1  Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
2  Department of Cardiovascular Surgery, Institute of Translational Cardiac Surgery (Insure), German Heart Center Munich, Technische Universität München, Munich, Germany
3  German Center for Cardiovascular Research (DZHK), Munich, Germany
,
Johanna Schechtl
1  Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
2  Department of Cardiovascular Surgery, Institute of Translational Cardiac Surgery (Insure), German Heart Center Munich, Technische Universität München, Munich, Germany
,
Magdalena Erlebach
1  Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
2  Department of Cardiovascular Surgery, Institute of Translational Cardiac Surgery (Insure), German Heart Center Munich, Technische Universität München, Munich, Germany
,
Konstantinos Sideris
1  Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
2  Department of Cardiovascular Surgery, Institute of Translational Cardiac Surgery (Insure), German Heart Center Munich, Technische Universität München, Munich, Germany
,
Rüdiger Lange
1  Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
2  Department of Cardiovascular Surgery, Institute of Translational Cardiac Surgery (Insure), German Heart Center Munich, Technische Universität München, Munich, Germany
3  German Center for Cardiovascular Research (DZHK), Munich, Germany
,
Sabine Bleiziffer
1  Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
2  Department of Cardiovascular Surgery, Institute of Translational Cardiac Surgery (Insure), German Heart Center Munich, Technische Universität München, Munich, Germany
3  German Center for Cardiovascular Research (DZHK), Munich, Germany
› Author Affiliations
Further Information

Publication History

18 October 2018

25 March 2019

Publication Date:
15 May 2019 (online)

Abstract

Background There is a growing use of cerebral protection devices in patients undergoing transcatheter aortic valve replacement (TAVR). We aimed to analyze if the use of these devices itself has an impact on the complexity and the risk of TAVR.

Methods Between February 2016 and July 2017, 391 patients underwent transfemoral TAVR with Medtronic CoreValve Evolut R (n = 196) or Edwards Sapien 3 (n = 195). In 39 patients, the Claret Sentinel™ embolic protection device (CS-EPD) was used. Prospectively collected data were retrospectively analyzed, comparing fluoroscopy/operation time, amount of contrast used, vascular events, and postprocedural renal function in TAVR patients with (n = 39) and without (n = 352) CS-EPD.

Results The CS-EPD was placed through the right radial (n = 35) or brachial (n = 4) artery. Procedural success rate defined as correct deployment and retraction of both filters was 94.9%. No device-related vascular complications occurred. TAVR patients with CS-EPD showed a significantly higher total operation time, total fluoroscopy time, and amount of used contrast (85.4 ± 39.3 vs. 64 ± 29.8 minutes, p = 0.002; 20.7 ± 9.3 vs. 13.7 ± 7 minutes, p ≤ 0.001; 133.7 ± 42.6 vs. 109.7 ± 44.5 mL, p = 0.001). Comparing the initial third of patients receiving a CS-EPD with the last third of CS-EPD cases, procedural time had decreased significantly (102.5 ± 34.9 vs. 67 ± 11.9; p = 0.002). There were no differences in postprocedural renal failure (p = 0.80).

Conclusion Our data add evidence that the application of the CS-EPD is not associated with an additional risk for the patient. Although procedural time and amount of contrast are still higher when using the CS-EPD, there were no device-related complications or increased incidence of renal failure.

Note

Presented at the 47th Annual Meeting of DGTHG, 17.-20.02.2018 in Leipzig, Germany.