Author + information
- Received March 15, 2018
- Revision received May 17, 2018
- Accepted June 5, 2018
- Published online September 3, 2018.
- Julia Seeger, MDa,
- Renu Virmani, MDb,
- Maria Romero, MDb,
- Birgid Gonska, MDa,
- Wolfgang Rottbauer, MDa and
- Jochen Wöhrle, MDa,∗ ()
- aDepartment of Internal Medicine II, Cardiology, University of Ulm, Ulm, Germany
- bCV Path Institute, Gaithersburg, Maryland
- ↵∗Address for correspondence:
Prof. Dr. Jochen Wöhrle, University Hospital of Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
Objectives The aim of this study was to evaluate the debris captured by the Claret Sentinel cerebral embolic dual-filter protection device during transfemoral transcatheter aortic valve replacement (TAVR) with different valve types.
Background Risk for embolization of debris during TAVR may vary by TAVR device.
Methods The filters of 100 consecutive patients were collected and captured debris was analyzed by histopathology and histomorphometry. Three valve types were implanted: the balloon-expandable Edwards SAPIEN 3 (n = 42), the self-expandable Medtronic Evolut R (n = 35), and the mechanically implantable Boston Scientific Lotus (n = 23).
Results Among the 3 groups there was no difference in baseline data, including Society of Thoracic Surgeons score for mortality, calcification, or pre-dilation. The type of captured debris did not differ among the 3 valve types in the proximal or distal filter. With the balloon-expandable valve, there were significantly more patients with large debris measuring ≥1,000 μm. The number of particles in the proximal filter was significantly lower with the Lotus (89.8 ± 106.3) compared with the Evolut R (187.3 ± 176.9) and Edwards SAPIEN 3 (172.3 ± 133.5) valves (p = 0.035). Total tissue area in the proximal filter was significantly smaller for the Lotus compared with the other 2 valve types (7.1 ± 6.3, 20.1 ± 19.0, and 21.3 ± 15.1 mm2; p = 0.0014). In contrast, for the distal filter, there were no differences with respect to valve type for total tissue area, particle size, and number of particles.
Conclusions A significant difference was observed in the size and number of captured tissue particles with the double-filter embolic protection device among different valve types in patients undergoing TAVR. The largest particles were observed in patients treated with a balloon-expandable valve.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 15, 2018.
- Revision received May 17, 2018.
- Accepted June 5, 2018.
- 2018 American College of Cardiology Foundation