Sentinel Protection for TAVR


LOS ANGELES, Calif. (Ivanhoe Newswire) — One of Robert Friedman’s doctors described him as a “dead man walking” before he had his aortic valve replaced. He had several heart issues that made even non-invasive surgery dangerous and the risk of stroke highly possible. His cardiologist was able to get a new device for Robert that gave him a new lease on life.

“I have felt great. I feel better than I’ve ever felt in my life. Tremendous energy. Gung ho. Just amazing,” Robert Friedman told Ivanhoe.

That wasn’t the case for Robert Friedman, 73, a year ago. He needed a heart valve replaced, but poor heart function and a clot in his left ventricle made that dangerous, even with a minimally-invasive procedure called TAVR.

Cardiologist Dr. Raj Makkar believed the sentinel cerebral protection system or CPS might protect Robert from stroke. About one in ten TAVR patients suffer stroke because of debris like this- dislodged during the valve replacement and caught in the filters.

“These filters stay there while we are doing our work and changing the heart valve so that the debris hits the filter rather than actually going into the brain.” Raj Makkar, MD, Director, Interventional Cardiology and Cath Lab at Cedars-Sinai Heart Institute explained. (Read Full Interview)

Doctor Makkar inserts the sentinel through the arm, so it can catch debris and calcium dislodged during TAVR, then removes it. It adds about five minutes and reduced TAVR-related stroke by 63 percent in the first 72 hours.

Doctor Makkar continued, “I think it’s a good idea not to have debris go into the brain even if it doesn’t cause stroke. It might have some impact on the long-term health of the brain.”

Robert is just glad he can again stroll with his wife, Anita.

Doctor Makkar says the sentinel filter catches debris in most patients and will work for about 90 percent of patients needing TAVR. Doctors are trained to use the system at Cedars-Sinai, Emory University, the Cleveland Clinic, and Mount Sinai or New York Presbyterian.

Contributors to this news report include: Wendy Chioji, Field Producer; Rusty Reed, Videographer; Cyndy McGrath, Supervising Producer; Gabriella Battistiol, Assistant Producer; Roque Correa, Editor.

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REPORT:          MB #4307

BACKGROUND: TAVR is a minimally-invasive surgical procedure that repairs the aortic valve without removing the old, damaged one. Instead, the replacement is wedged into place. The full name for this procedure is a transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI). Similar to a stent placed in an artery, this approach delivers a fully collapsible replacement valve to the site through a catheter. Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating the blood flow. This procedure is different from the standard valve replacement, it is fairly new and for those patients considered at intermediate or high risk for standard valve replacement.

RISK OF STROKE: Though uncommon, stroke is one of the most feared complications when it comes to the TAVR procedure. Most of these strokes occur during the actual procedure itself or in the first few days following. It is likely due to having to pass the valve through the great vessels to reach the heart. This potentially dislodges small particles of plaque buildup that have formed on the walls. These then fly up to the brain and cause blockages which result in a stoke.


NEW TECHNOLOGY: A new, first and only device FDA-cleared and available in the US to reduce the risk of stroke during TAVR, it is called the sentinel cerebral protection system or CPS. It consists of filters which are inserted through the arm and inflated to catch the debris and calcium dislodged during TAVR. It adds a total of about five minutes to the procedure and reduces TAVR-related stroke by 63 percent in the first 72 hours. CPS catches debris in most patients and will work for about 90 percent of patients who need TAVR.

(Source: Raj Makkar, MD


Catherine Pope

If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Marjorie Bekaert Thomas at

Doctor Q and A

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