von Kemp Marnix J, Floré Vincent, Lau Chirik Wah, De Sutter Johan, Provenier Frank, Cornelis Kristoff
Cardiology Department, Hartcentrum, AZ Maria Middelares, Ghent, Belgium.
Vrije Universiteit Brussel (VUB) Departement Cardiologie, Brussel, Belgium.
Acta Cardiol. 2022 Dec;77(10):922-929. doi: 10.1080/00015385.2022.2111128. Epub 2022 Aug 31.
Stroke is a major concern in transcatheter aortic valve replacement (TAVR). The introduction of a cerebral protection devices may counteract the evolution towards minimally invasive TAVR. At this time, there is insufficient data to support the routine use of these devices.
We aimed to evaluate the outcome of the routine use of the Sentinel Cerebral protection system (CPS) in patients undergoing TAVR, after completing a CT-based screening process for feasibility of Sentinel implantation. We report our initial experience with the routine implementation of the Sentinel CPS in all anatomically suitable patients undergoing TAVR. We retrospectively compared the procedural characteristics and outcomes between all TAVR patients treated with ( = 78) and without ( = 79) intended Sentinel.
The Sentinel CPS could successfully be deployed in 99% of intended cases after CT feasibility screening. TAVR procedures with Sentinel CPS were not longer than procedures without Sentinel use (89 ± 20 versus 120 ± 50 min, = 0.007). Sentinel CPS use was not associated with an increased risk of procedural complications. Stroke was observed in none (0%) of the Sentinel CPS patients, and in 6.3% of the non-Sentinel CPS patients ( = 0.05). The finding of stroke was associated with a high risk of early postprocedural mortality: 60% of stroke patients died within 3 months.
Routine use of the Sentinel CPS in CT-screened TAVR patients is feasible with high procedural success, without significant adverse events and without counteracting the evolution towards minimally invasive TAVR. Clinically relevant stroke was observed in none of the Sentinel CPS patients.
中风是经导管主动脉瓣置换术（TAVR）中的一个主要问题。脑保护装置的引入可能会阻碍向微创TAVR的发展。目前，尚无足够数据支持常规使用这些装置。
在完成基于CT的Sentinel植入可行性筛查后，我们旨在评估在接受TAVR的患者中常规使用Sentinel脑保护系统（CPS）的结果。我们报告了在所有解剖结构合适的接受TAVR的患者中常规实施Sentinel CPS的初步经验。我们回顾性比较了所有接受（n = 78）和未接受（n = 79）意向性Sentinel治疗的TAVR患者的手术特征和结果。
经过CT可行性筛查后，99%的意向性病例中Sentinel CPS能够成功部署。使用Sentinel CPS的TAVR手术时间并不长于未使用Sentinel的手术（89 ± 20分钟对120 ± 50分钟，P = 0.007）。使用Sentinel CPS与手术并发症风险增加无关。Sentinel CPS组患者无一例（0%）发生中风，非Sentinel CPS组患者中风发生率为6.3%（P = 0.05）。中风的发生与术后早期高死亡率相关：60%的中风患者在3个月内死亡。
在经CT筛查的TAVR患者中常规使用Sentinel CPS是可行的，手术成功率高，无明显不良事件，且不会阻碍向微创TAVR的发展。Sentinel CPS组患者无一例发生具有临床意义的中风。
