Pro and ConPro: Routine Use of Embolic Protection Devices in Transcatheter Aortic Valve Replacement Should Be Considered
Section snippets
Embolic Protection Devices
Embolic protection devices have been developed as a potential method to mitigate cerebral embolization and the associated neurologic sequelae during TAVR. Four distinct devices have been tested in prospective studies and randomized, controlled trials.22, 42, 46 The common feature of all current devices involves percutaneous deployment of a porous membrane apparatus at the level of the aortic arch or great vessels, which either filters or deflects emboli while allowing for unrestricted blood
Discussion
The results of the aforementioned trials are encouraging and demonstrate that embolic phenomena occurring during TAVR can be attenuated, as seen with DW-MRI, with a potential reduction in neurologic insult. The MISTRAL-C and CLEAN-TAVI trials have highlighted the ability of these devices to reduce cerebral embolism, and as newer technologies develop, it is conceivable that embolic protection devices will play an important role in further maximizing the safety of TAVR. It is well established
Conclusion
Major stroke after TAVR has devastating consequences and has been described by some as a “fate worse than death.”66 With the advancement of technique and design of delivery systems and valves, it is evident that the success of TAVR will only be enhanced by the application of risk-minimization strategies to provide outcomes superior to SAVR. Although there are multiple approaches to help minimize the risk of stroke in TAVR due to its variable causes, the mechanical advantage of embolic filter
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2018, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :Their common feature is the percutaneous deployment of a porous membrane device within the aortic arch to filter or deflect emboli without restricting blood flow to the central nervous system.58,59 The Embrella Embolic Deflector (Edwards Lifesciences, Irvine, CA) consists of 2 porous polyurethane petals within a nitinol frame that are deployed through the right radial or brachial artery to cover the ostium of the right brachiocephalic trunk and the left common carotid artery (Figs 1 and 2).58–60 Blood flows freely through the 100 µm filters, whereas larger emboli are deflected downstream away from the cerebral circulation.60
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