Cerebral protection during transcatheter aortic valve implantation: An updated systematic review and meta-analysis

Background--The use of embolic protection devices (EPD) may theoretically reduce the occurrence of cerebral embolic lesions during transcatheter aortic valve implantation. Available evidence from single studies is inconclusive. The aim of the present metaanalysis was to assess the safety and efficacy profile of current EPD. Methods and Results--Major medical databases were searched up to December 2017 for studies that evaluated patients undergoing transcatheter aortic valve implantation with or without EPD. End points of interest were 30-day mortality, 30-day stroke, the total number of new lesions, the ischemic volume per lesion, and the total volume of lesions. Eight studies involving 1285 patients were included. The EPD delivery success rate was reported in all studies and was achieved in 94.5% of patients. The use of EPD was not associated with significant differences in terms of 30-day mortality (odds ratio 0.43 [0.18-1.05], P=0.3) but it was associated with a lower rate of 30-day stroke (odds ratio 0.55 [0.31-0.98], P=0.04). No differences were detected with respect to the number of new lesions (standardized mean difference -0.19 [-0.71 to 0.34], P=0.49). The use of EPD was associated with a significantly smaller ischemic volume per lesion (standardized mean difference, -0.52 [-0.85 to -0.20], P=0.002) and smaller total volume of lesions (standardized mean difference, -0.23 [-0.42 to -0.03], P=0.02). Conclusions--The use of EPD is not associated with a reduced rate of mortality and new ischemic cerebral lesions. The use of EPD during transcatheter aortic valve implantation seems to be associated with a lower 30-day stroke rate, although this result is driven by a single nonrandomized study. The use of EPD is associated with a smaller volume of ischemic lesions, and smaller total volume of ischemic lesions.