Cerebral embolic protection during transcatheter aortic valve replacement: a systematic review and meta-analysis of propensity score matched and randomized controlled trials using the Sentinel cerebral embolic protection device

BMC Cardiovascular Disorders

Research

Ruediger C. Braun-Dullaeus¹  Immanuel Justus Handerer¹  Alexander Schmeisser¹  Federico Moccetti²  Stefan Toggweiler²  Mathias Wolfrum³ 

[1] Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Magdeburg, Germany;Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland;Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland;Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Magdeburg, Germany;

关键词: Aortic stenosis;    TAVR;    Transcatheter aortic valve replacement;    Cerebral protection;    Outcomes;   

DOI  :  10.1186/s12872-023-03338-0

 received in 2022-12-05, accepted in 2023-06-08,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe Sentinel cerebral embolic protection device (CEP) aims to reduce the risk of stroke during transcatheter aortic valve replacement (TAVR). We performed a systematic review and meta-analysis of propensity score matched (PSM) and randomized controlled trials (RCT) investigating the effect of the Sentinel CEP to prevent strokes during TAVR.MethodsEligible trials were searched through PubMed, ISI Web of science databases, Cochrane database, and proceedings of major congresses. Primary outcome was stroke. Secondary outcomes included all-cause mortality, major or life-threatening bleeding, major vascular complications and acute kidney injury at discharge. Fixed and random effect models were used to calculate the pooled risk ratio (RR) with 95% confidence intervals (CI) and absolute risk difference (ARD).ResultsA total of 4066 patients from 4 RCTs (3′506 patients) and 1 PSM study (560 patients) were included. Use of Sentinel CEP was successful in 92% of patients and was associated with a significantly lower risk of stroke (RR: 0.67, 95% CI: 0.48–0.95, p = 0.02. ARD: -1.3%, 95% CI: -2.3 – -0.2, p = 0.02, number needed to treat (NNT) = 77), and a reduced risk of disabling stroke (RR: 0.33, 95% CI: 0.17–0.65. ARD: -0.9%, 95% CI: -1.5 – -0.3, p = 0.004, NNT = 111). Use of Sentinel CEP was associated with a lower risk of major or life-threatening bleeding (RR: 0.37, 95% CI: 0.16–0.87, p = 0.02). Risk for nondisabling stroke (RR: 0.93, 95% CI: 0.62–1.40, p = 0.73), all-cause mortality (RR: 0.70, 95% CI: 0.35–1.40, p = 0.31), major vascular complications (RR: 0.74, 95% CI: 0.33–1.67, p = 0.47) and acute kidney injury (RR: 0.74, 95% CI: 0.37–1.50, p = 0.40) were similar.ConclusionsThe use of CEP during TAVR was associated with lower risks of any stroke and disabling stroke with an NNT of 77 and 111, respectively.

【 授权许可】

CC BY   
© The Author(s) 2023

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