The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Heterogeneity of debris captured by cerebral embolic protection filters during TAVI

DOI: 10.4244/EIJ-D-20-00744

1. Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
2. Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
3. Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands, Netherlands
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Aims
To investigate the total amount, size and heterogeneity of debris captured among different transcatheter valve types and while repositioning.

Methods and Results
A total of 328 patients who underwent transcatheter aortic valve implantation (TAVI) with Sentinel cerebral embolic protection (CEP) at our center were eligible. Histopathological and semiquantitative analysis of captured debris was performed and data was entered in our prospective database.
TAVI was performed with either the Evolut R/PRO (N=123), Sapien3 (N=113) or Lotus valve (N=92). Capture of debris occurred in 98% of patients. Lotus TAVI resulted in more frequent foreign body material (62% vs. 40% vs. 47%, P=0.006), endothelium (49% vs. 30% vs. 16%, P<0.0005), calcified material (33% vs. 12% vs. 24%, P=0.001) and myocardial tissue (19% vs. 11% vs. 2%, P<0.0005) compared to Sapien3 or Evolut R/PRO. Native (functional) bicuspid valves (OR 2.91, 95% CI 1.20-7.03, P=0.02) and Lotus (OR 2.44, 95% CI 1.14-5.24, P=0.02) were associated with the highest risk for dislodging particles ≥1000um. Valve repositioning was independently associated with larger debris amounts (OR 2.96, 95% CI 1.42-6.16, P=0.004).

Conclusion
All THV platforms had similar amounts of captured debris. THV repositioning seemed associated with a higher risk for dislodging greater amounts of debris to the brain.

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