Cerebral embolic protection devices (CEPD) during transcatheter aortic valve replacement (TAVR) have been shown to lower the risk of stroke during the procedure. However, their long-term and clinical effects on neuro-cognition are unknown. Therefore, we hypothesized the benefit of CEPD in TAVR patients with a prior history of stroke or transient ischemic attack (TIA). National Inpatient Sample (2019) and International Classification of Diseases, 10th Revision codes were used to identify patients undergoing TAVR with prior stroke or TIA. Propensity-matched analysis was performed to adjust for baseline characteristics and comorbidities. Primary outcome measures were postoperative stroke and all-cause mortality. Length of stay and hospital cost were secondary outcomes. Of 8450 unmatched TAVR patients with prior stroke or TIA in 2019, 1095 (13%) utilized CEPD. After propensity matching previous myocardial infarction (MI), coronary artery bypass grafting, and drug abuse were higher in the TAVR-only cohort. Postoperative stroke rate (1.4% vs 2.2%; P = 0.081) and odds [adjusted odds ratio (aOR), 0.48; 95% confidence interval (CI), 0.11-2.17; P = 0.341] were lower in the CEPD group. There was no difference in all-cause in-hospital mortality between the 2 groups (0.9% vs 1.0%). Length of stay (3 vs 2 days, P <0.001) and hospital expenditure ($172,711 vs $162,284; P = 0.002) were higher for the TAVR-only cohort. CEPD in TAVR patients with prior stroke or TIA did not show statistically significant postoperative stroke benefits. However, further larger-scale prospective studies are needed to evaluate the long-term neurocognitive benefits of CEPD in these patients. As the use of TAVR continues to expand, optimizing peri-procedural strategies such as the use of CEPD remains a critical area of research to improve patient outcomes.

中文翻译：

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检查脑栓塞保护装置在预防有中风或短暂性缺血病史的患者术后中风中的作用：来自全国住院患者样本的见解。

经导管主动脉瓣置换术 (TAVR) 期间的脑栓塞保护装置 (CEPD) 已被证明可以降低手术过程中中风的风险。然而，它们对神经认知的长期和临床影响尚不清楚。因此，我们假设 CEPD 对既往有中风或短暂性脑缺血发作 (TIA) 病史的 TAVR 患者有益。使用国家住院患者样本 (2019) 和国际疾病分类第 10 版代码来识别既往有中风或 TIA 且接受 TAVR 的患者。进行倾向匹配分析以调整基线特征和合并症。主要结局指标是术后卒中和全因死亡率。住院时间和住院费用是次要结果。2019 年，在 8450 名未匹配的既往有中风或 TIA 的 TAVR 患者中，1095 名 (13%) 使用了 CEPD。在与既往心肌梗死（MI）、冠状动脉搭桥术和药物滥用倾向相匹配后，仅 TAVR 队列中的倾向较高。术后卒中发生率（1.4% vs 2.2%；P = 0.081）和赔率[调整赔率比 (aOR)，0.48；95%置信区间（CI），0.11-2.17；CEPD 组的 P = 0.341] 较低。两组之间的全因住院死亡率没有差异（0.9% vs 1.0%）。仅 TAVR 队列的住院时间（3 天 vs 2 天，P <0.001）和住院费用（172,711 美元 vs 162,284 美元；P = 0.002）较高。对于既往有中风或 TIA 的 TAVR 患者，CEPD 并未显示出具有统计学意义的术后中风获益。然而，需要进一步更大规模的前瞻性研究来评估 CEPD 对这些患者的长期神经认知益处。随着 TAVR 的使用不断扩大，优化围手术期策略（例如使用 CEPD）仍然是改善患者预后的关键研究领域。