The Self-Expanding Symetis Acurate Does Not Increase Cerebral Microembolic Load When Compared to the Balloon-Expandable Edwards Sapien Prosthesis: A Transcranial Doppler Study in Patients Undergoing Transapical Aortic Valve ImplanReportar como inadecuado




The Self-Expanding Symetis Acurate Does Not Increase Cerebral Microembolic Load When Compared to the Balloon-Expandable Edwards Sapien Prosthesis: A Transcranial Doppler Study in Patients Undergoing Transapical Aortic Valve Implan - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Objectives

The aim of this study was to quantify potential differences in count, frequency and pattern of high-intensity transient signals HITS during transapical transcatheter aortic valve implantation TA-TAVI, by comparing the Symetis Acurate TA SA with the balloon-expandable Edwards Sapien XT ES system.

Background

Recently, the Symetis Acurate TA revalving system has been introduced for TA-TAVI. The Symetis Acurate TA aortic bioprosthesis is self-expanding and is deployed by a specific two-step implantation technique. Whether this novel method increases the load of intraprocedural emboli, detected by transcranial Doppler ultrasound TCD as HITS, or not is not clear.

Methods

Twenty-two patients n = 11 in each study arm, median logistic EuroScore 20%, median STS score 7% displayed continuous TCD signals of good quality throughout the entire TA-TAVI procedure and were included in the final analysis. Data are presented as median with interquartile ranges.

Results

No significant differences were detected in total procedural or interval-related HITS load SA: 303 200; 594, ES: 499 285; 941; p = 0.16. With both devices, HITS peaked during prosthesis deployment PD, whereas significantly fewer HITS occurred during instrumentation SA: p = 0.002; ES: <0.001 or post-implantation PI SA: p = 0.007; ES: <0.001. PD-associated HITS amounted to almost half of the total HITS load. One patient suffered new disabling stroke at 30 days. Thirty-day mortality amounted to 13.6% 3 of 22 patients.

Conclusions

Simplified transapical delivery using the self-expanding SA device does not increase HITS, despite of a two-step deployment technique with more interactions with the native aortic valve, when compared to the balloon-expandable ES valve. The similarity in HITS count, frequency and pattern with the two systems suggests a common mechanism for the release of cerebral microemboli.



Autor: Gabor Erdoes , Christoph Huber, Reto Basciani, Stefan Stortecky, Stephan Windecker, Peter Wenaweser, Thierry Carrel, Balthasar Eb

Fuente: http://plos.srce.hr/



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