TAVR Focus Issue
Clinical Research
Incidence and Predictors of Debris Embolizing to the Brain During Transcatheter Aortic Valve Implantation

https://doi.org/10.1016/j.jcin.2015.01.020Get rights and content
Under an Elsevier user license
open archive

Abstract

Objectives

The aim of this study was to identify variables associated with tissue fragment embolization during transcatheter aortic valve replacement (TAVR).

Background

Brain magnetic resonance imaging and transcranial Doppler studies have revealed that cerebrovascular embolization occurs frequently during TAVR. Embolized material may be r thrombotic, tissue derived, or catheter (foreign material) fragments.

Methods

A total of 81 patients underwent TAVR with a dual filter–based embolic protection device (Montage Dual Filter System, Claret Medical, Inc., Santa Rosa, California) deployed in the brachiocephalic trunk and left common carotid artery. Both balloon-expandable and self-expanding transcatheter heart valves (THVs) were used. Filters were retrieved after TAVR and sent for histopathological analysis.

Results

Overall, debris was captured in 86% of patients. Captured material varied in size from 0.1 to 9.0 mm. Thrombotic material was found in 74% of patients and tissue-derived debris in 63%. Tissue fragments were found more often with balloon-expandable THVs (79% vs. 56%; p = 0.05). The embolized tissue originated from the native aortic valve leaflets, aortic wall, or left ventricular myocardium. On multivariable logistic regression analysis, balloon-expandable THVs (odds ratio: 7.315; 95% confidence interval: 1.398 to 38.289; p = 0.018) and cover index (odds ratio: 1.141; 95% confidence interval: 1.014 to 1.283; p = 0.028) were independent predictors of tissue embolization.

Conclusions

Debris is captured with filter-based embolic protection in the vast majority of patients undergoing TAVR. Tissue-derived material is found in 63% of cases and is more frequent with the use of balloon-expandable systems and more oversizing.

Key Words

aortic stenosis
embolization
TAVR

Abbreviations and Acronyms

ACT
activated clotting time
BAV
balloon aortic valvuloplasty
EPD
embolic protection device
IQR
interquartile range
SAVR
surgical aortic valve replacement
TAVR
transcatheter aortic valve replacement
THV
transcatheter heart valve

Cited by (0)

Dr. Van Mieghem has received research grants from Claret Medical Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.