Debris Heterogeneity Across Different Valve Types Captured by a Cerebral Protection System During Transcatheter Aortic Valve Replacement

作者：Schmidt Tobias^*; Leon Martin B; Mehran Roxana; Kuck Karl Heinz; Alu Maria C; Braumann Ryan E; Kodali Susheel; Kapadia Samir R; Linke Axel; Makkar Raj; Naber Christoph; Romero Maria E; Virmani Renu; Frerker Christian

来源：JACC: Cardiovascular Interventions , 2018, 11(13): 1262-1273.

DOI：10.1016/j.jcin.2018.03.001

• cerebral protection
• histopathologic analysis
• SENTINEL
• TAVR

OBJECTIVES This study investigated differences between transcatheter heart valve (THV) types and regarding debris captured by a cerebral embolic protection system (Claret Medical Sentinel, Santa Rosa, California).
BACKGROUND Differences of THV types and cerebral injury after transcatheter aortic valve replacement (TAVR) are not welt understood.
METHODS A total of 246 patients pooled from 2 prospective studies (SENTINEL [Cerebral Protection in Transcatheter Aortic Valve Replacement] trial, N = 100; SENTINEL-H [Histopathology of Embolic Debris Captured During Transcatheter Aortic Valve Replacement] trial, N = 146) were included in the analysis. Histopathologic assessment and histomorphometric analyses of debris were compared with THV types. Analyses were differentiated by particle size (>= 150, >= 500, and >= 1,000 mu m), particle count, total particle area, and maximum of largest dimension. Only commercially available THVs were included: 16% Evolut R (EvR), 15% Lotus, 59% SAPIEN 3 (53), and 10% SAPIEN XT (XT).
RESULTS Particles were captured in 99% of patients. There was a significantly higher amount of debris related to the vascular bed (valve tissue, arterial watt, calcification) in EvR patients compared with S3 patients; 53% of all patients irrespective of valve type had at least 1 particle >= 1 mm. Larger particles (>= 500 and >= 1,000 mu m) were significantly more frequent in EvR than XT and S3 patients. Lotus patients with particles >= 1,000 mu m were significantly more frequent than in S3 patients. Particle count, total particle area, and maximum of largest dimension were significantly higher in both Lotus and EvR patients compared with S3 and XT.
CONCLUSIONS Debris was captured in 99% of patients, of whom 53% had at least 1 particle of debris >1 mm. The number and size of particles captured during a procedure in which EvR or Lotus THV was used were higher and larger than with a Sapien THV. Regardless, embolic debris, including large particles, is universal across valve types and provides mechanistic support for the potential benefit of using cerebral embolic protection in all TAVR procedures.

• 出版日期2018-7-9