Anatomical reasons for failure of dual‐filter cerebral embolic protection application in TAVR: A CT‐based analysis. Issue 12 (27th September 2021)

• Record Type: Journal Article
• Authors: Voss, Stephanie; Campanella, Caterina; Burri, Melchior; Trenkwalder, Teresa; Sideris, Konstantinos; Erlebach, Magdalena; Ruge, Hendrik; Krane, Markus; Vitanova, Keti; Lange, Rüdiger
• Is Part Of: Journal of cardiac surgery. Volume 36:Issue 12(2021)
• Page Start: 4537
• Page End: 4545
• Publication Date: 2021-09-27
• Subjects: cerebral embolic protection -- device failure -- dual‐filter embolic protection -- TAVR; Heart -- Surgery -- Periodicals; 617.412005
• DOI: 10.1111/jocs.16025
• Languages: English
• ISSNs: 0886-0440

Abstract

Abstract: Background: The dual‐filter Sentinel™ Cerebral Protection System (Sentinel‐CPS) is increasingly used during transcatheter aortic valve replacement (TAVR). However, complex vascular anatomy may challenge Sentinel‐CPS deployment. Aim of the study: We sought to investigate the impact of anatomic features of the aortic arch and the supra‐aortic arteries on technical device failure of Sentinel‐CPS application. Methods: Analysis of the multislice computed tomography pre‐TAVR aortograms of all patients undergoing TAVR with Sentinel‐CPS between 2016 and 2020 ( n = 92) was performed. We investigated the impact of aortic arch anatomy, configuration, and the angles of the supra‐aortic arteries, including the determination of vascular tortuosity index on device failure of Sentinel‐CPS application. Results: The Sentinel‐CPS was applied successfully in 83 patients (90.2%). Device failure in nine patients (9.8%) was due to the infeasibility to perform correct deployment of both filters ( n = 7) and to obtain peripheral radial access ( n = 2). Patients with a failure of Sentinel‐CPS application had a higher right subclavian tortuosity index (217 [92–324] vs. 150 [42–252], p = .046), a higher brachiocephalic tortuosity index (27 [5–51] vs. 10 [0–102], p = 0.033) and a larger angulation of the brachiocephalic artery (59° [22–80] vs. 39° [7–104], p = .014) compared with patients with successful application. A brachiocephalic angle more than 59° was predictive for device failure. No differences in aortic arch anatomy or common carotid artery tortuosity were detected between the groups. Conclusions: Brachiocephalic tortuosity was found to be associated with failure of Sentinel‐CPS application. Filter‐based usage should be avoided in TAVR patients with a brachiocephalic angle more than 59°.