Safety and efficacy of cerebral embolic protection systems in transcatheter aortic valve replacement: a systematic review and meta-analysis.

Background: Stroke is a potentialcomplication of Transcatheter Aortic Valve Replacement (TAVR). Recent trials evaluating Cerebral Embolic ProtectionSystems(CEPS) to reduce the incidence of stroke after TAVR have been conflicting.

Methods: Multiple databaseswere searched for studies comparing TAVR with or without CEPS and that reportedon the primary outcome of periprocedural stroke. Two authors individuallyscreened the titles, the abstracts and the full texts using Covidence. Risk ofbias was assessed using Cochrane's ROB-2 and ROBINS-I tools.

Results: 15 studies (3 randomized controlled trials, 7 national registries, and 5cohort studies) met the eligibility criteria and were included in our review. CEPS was associatedwith lower rates of periprocedural stroke [OR 0.71 (95% CI 0.55, 0.93) = 0.012], as well as lower rates of mortality [OR 0.60 (95% CI 0.49, 0.74) < 0.001]. There was no significant difference between the two groups in theincidence of acute kidney injury [OR 0.91 (95% CI 0.82, 1.01)  = 0.087], majorvascular complications [OR 0.97 (95% CI 0.83, 1.14)  = 0.734], and major life-threateningbleeding [OR 0.89 (95% CI 0.73, 1.07)  = 0.222].

Conclusions: Our findings suggest that the use of CEPS in TAVR is associated with alower risk of periprocedural stroke and mortality.

Registration: The PROSPERO identification number is CRD42022374055.