title: Histology of debris captured by a cerebral protection system during transcatheter valve-in-valve implantation.
abstract: Histological analyses of debris captured by a cerebral protection system (CPS) during transcatheter valve-in-valve (VIV) procedures have not been reported.
  
  
  
  Fifteen consecutive patients with stenotic aortic (n=13) or mitral (n=2) surgical or transcatheter bioprostheses were treated with implantation of a transcatheter heart valve (THV) in the presence of a dual-filter CPS. Mean patient age was 75 years; mean logistic EuroSCORE was 31%. Filters were collected and histological assessment of debris was performed. Patients were followed clinically until discharge.
  
  
  
  Debris captured by either or both filters was detected in all patients. Acute thrombus was the most common type of debris, found in all patients, followed in frequency by arterial wall tissue (n=12 patients (80%)), calcification (n=11 (73%)) and valve tissue (n=9 (60%)). Less frequently found were organised thrombus (n=5 (30%)), foreign material (n=4 (27%)) and myocardium (n=2 (13%)). A median of 123 debris particles per patient was detected, with a trend towards a greater median number of particles collected in proximal filters (78 vs 39, p=0.065). The average maximum particle diameter was 88 (range 56-175) µm, with a median of 20 particles ≥150 µm. No stroke or transient ischaemic attack (TIA) had occurred by the time of discharge (mean 8 days).
  
  
  
  Transcatheter VIV procedures were associated with the release of particulate debris into the cerebral circulation in all patients. The type of debris suggests that debris originates predominantly from arterial and valvular passage of the THV.
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Schmidt
authors.affiliation: Asklepios Proresearch, Hamburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Schlüter
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Hannes
authors.initials: H
authors.lastname: Alessandrini
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Ozan
authors.initials: O
authors.lastname: Akdag
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Dimitry
authors.initials: D
authors.lastname: Schewel
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Jury
authors.initials: J
authors.lastname: Schewel
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Thielsen
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Kreidel
authors.affiliation: Department of Cardiothoracic Surgery, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Bader
authors.affiliation: CVPath Institute, Inc., Gaithersburg, Maryland, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Romero
authors.affiliation: CVPath Institute, Inc., Gaithersburg, Maryland, USA.
authors.forename: Elena
authors.initials: E
authors.lastname: Ladich
authors.affiliation: CVPath Institute, Inc., Gaithersburg, Maryland, USA.
authors.forename: Renu
authors.initials: R
authors.lastname: Virmani
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schäfer
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Frerker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D057505:Embolic Protection Devices; D005260:Female; D005858:Germany; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D020767:Intracranial Thrombosis / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019233:Retreatment; D016896:Treatment Outcome
keywords: Stroke