Association of Self-Expanding Valves with Increased Capture of Larger Debris by Cerebral Protection System in Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis

Background: Mixed evidence exists regarding stroke rates when comparing self-expanding valves (SEVs) to balloon-expandable valves (BEVs) in transcatheter aortic valve replacement (TAVR). This study investigates the debris captured by the SENTINEL cerebral protection system (CPS) during TAVR.

Methods: Seventy-five consecutive patients who underwent TAVR with CPS from March to December 2023 were recruited. Collected debris underwent histopathologic analysis, categorized by size (< 2 mm, 2-5 mm, > 5 mm) and quantity. Logistic regression analysis was used to identify predictors for the presence of particles > 5 mm in size.

Results: Of the 75 patients, 39 received SEVs and 36 received BEVs. Baseline characteristics were similar between the groups. The BEV group had significantly more frequent concomitant percutaneous coronary interventions (p = 0.013), while the SEV group had longer TAVR procedure (p = 0.019) and fluoroscopy times (p = 0.006). All patients had visible debris, predominantly valve tissue (SEV vs. BEV = 79.8% vs. 47.2%; p = 0.308), calcification (SEV vs. BEV = 23.1% vs. 36.1%; p = 0.215), and thrombus (SEV vs. BEV = 15.4% vs. 5.6%; p = 0.855). No significant differences were observed in particle count and particle size < 5 mm between the SEV and BEV groups. However, logistic regression analysis revealed that the patients who received SEVs had a 16.78-fold increased likelihood of having captured debris > 5 mm compared to those who received BEVs.

Conclusions: Our study demonstrated that significantly more particles sized > 5 mm were captured by the CPS during TAVR in the SEV group, underscoring the importance of using the CPS during TAVR, especially in younger patients receiving SEVs.