Shekhar Shashank, Krishnaswamy Amar, Reed Grant, Yun James, Puri Rishi, Kapadia Samir
Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
Struct Heart. 2024 Sep 2;9(1):100353. doi: 10.1016/j.shj.2024.100353. eCollection 2025 Jan.
Limited studies are available which aim to identify patient populations that would potentially benefit from the use of cerebral embolic protection devices (CPDs) during transcatheter aortic valve replacement (TAVR). We aimed to analyze the impact of CPD use during TAVR among patients with atrial fibrillation (AF).
Data on adult TAVR patients with a concomitant diagnosis of AF was obtained from the 2017-2020 National Readmissions Database. Stroke, major stroke, in-hospital mortality, and 30-day readmission rates were compared between the CPD and no-CPD cohorts in a propensity score matched analysis. Association of CPD use with adverse events was analyzed using multivariable logistic regression models.
Of 100,928 eligible TAVR patients with AF, CPD was used in 6.9% of patients with a mean age of 80 years. CPD use was independently associated with lower overall stroke (1.7% vs. 2.2%; odds ratio [OR] 0.81 [95% CI 0.68-0.98]; = 0.032), major stroke (1.2% vs. 1.8%; OR 0.69 [0.55-0.86]; = 0.001), in-hospital mortality (0.9 vs. 1.5%; OR 0.56 [0.43-0.72]; < 0.001), and lower 30-day readmission rates (12.7% vs. 14.7%; OR 0.87 [0.81-0.94]; < 0.001). Reduction in adverse events with CPD was noted in high-volume but not in low-volume TAVR centers.
The present point towards clear benefits of CPD use among patients with AF undergoing TAVR. In anatomically eligible patients, the potential benefit of debris capture may be considered especially as younger and lower risk patients become eligible for TAVR. Data from future trials and registries are required to further corroborate our findings.
旨在确定在经导管主动脉瓣置换术（TAVR）期间可能从使用脑栓塞保护装置（CPD）中获益的患者群体的研究有限。我们旨在分析CPD在房颤（AF）患者TAVR期间使用的影响。
从2017 - 2020年国家再入院数据库中获取伴有AF诊断的成年TAVR患者的数据。在倾向评分匹配分析中比较CPD组和非CPD组之间的卒中、重大卒中、住院死亡率和30天再入院率。使用多变量逻辑回归模型分析CPD使用与不良事件的关联。
在100928例符合条件的AF合并TAVR患者中，6.9%的患者使用了CPD，平均年龄为80岁。使用CPD与总体卒中发生率降低独立相关（1.7%对2.2%；比值比[OR]0.81[95%CI 0.68 - 0.98]；P = 0.032）、重大卒中发生率降低（1.2%对1.8%；OR 0.69[0.55 - 0.86]；P = 0.001）、住院死亡率降低（0.9%对1.5%；OR 0.56[0.43 - 0.72]；P < 0.001）以及30天再入院率降低（12.7%对14.7%；OR 0.87[0.81 - 0.94]；P < 0.001）。在高容量TAVR中心观察到CPD使用使不良事件减少，但在低容量中心未观察到。
目前的研究表明CPD在接受TAVR的AF患者中使用有明显益处。在解剖结构合适的患者中，尤其是随着年轻和低风险患者符合TAVR条件，碎片捕获的潜在益处可能值得考虑。需要未来试验和注册研究的数据来进一步证实我们的发现。
