Abstract 4145577: Barriers to the Brain: Unveiling the Impact and Disparities of Sentinel Cerebral Protection in TAVR Patients

Background: The Sentinel Cerebral Protection System (SCPS) was initially demonstrated to lower stroke risk during transcatheter aortic valve replacement (TAVR). However, recent trials have failed to confirm these benefits and have excluded patients with specific risk factors that increase stroke risk. Research Question: What are the outcomes, utilization trends, and disparities in the use of the SCPS during TAVR procedures, and how do these outcomes vary by race, ethnicity, and income levels? Objective: To evaluate the impact of the SCPS on in-hospital mortality, complications, hospital costs, and length of stay in patients undergoing TAVR, and to identify trends and disparities in SCPS utilization across different racial, ethnic, and income groups. Methods: This retrospective study utilized the National Inpatient Sample to identify patients undergoing TAVR and SCPS from 2017 to 2020. The primary outcome was in-hospital all-cause mortality. Secondary outcomes included complications, hospital costs, and length of stay. Weighted multivariable logistic regression and chi-square tests were used to analyze outcomes, controlling for comorbidities, age, gender, and, when appropriate, race/ethnicity. Results: The study included 67,670 TAVR patients, with 4,410 using SCPS. SCPS prevalence increased from 180 to 2,790 over the study period without significant differences in mortality, length of stay, or cost compared to those without SCPS. Patients using SCPS had lower odds of stroke (OR: 0.48; p < 0.040) and post-procedural hemorrhage (OR: 0.682; p < 0.039). Hispanic patients utilizing SCPS had higher hospital costs ($55,983; p < 0.010) without a difference in length of stay. SCPS was less likely to be used in Black (OR: 0.49; p < 0.001) and Hispanic (OR: 0.36; p = 0.013) patients. Compared to White patients in the lowest income quartile, SCPS was more likely to be used in the second (OR: 1.28; p < 0.017), third (OR: 1.67; p < 0.001), and fourth (OR: 1.74; p < 0.001) quartiles. No similar income-based trend was observed for other racial or ethnic groups. Conclusion: No significant difference in in-hospital mortality was observed among patients using SCPS during TAVR. However, SCPS use was associated with lower odds of complications without changes in length of stay or cost. Despite these associated benefits and the absence of significant contraindications, disparities in SCPS utilization were observed across racial, ethnic, and income groups.