Comparison of Carbon Dioxide and Saline Flush to Saline Flush in TEVAR and TAVI Procedures to Reduce Cerebral Ischemia

Comparison of Carbon Dioxide Flush and Saline Flush to Saline Flush Alone in TEVAR and TAVI Procedures to Reduce Cerebral Ischemia

Thoracic endovascular repair (TEVAR) and transcatheter aortic valve implantation (TAVI) are standard of care procedures to treat thoracic aortic aneurysm or severe aortic stenosis, respectively. Both procedures have a high risk of stroke and silent infarction. Gas has been detected in the cerebral vasculature during these procedures and associated with DWI positive lesions on MRI. The hypothesis is that air emboli contribute to stroke and silent infarction. The investigators propose addressing air emboli by flushing the device with carbon dioxide prior to flushing with saline. This is a pilot study comparing standard saline flush alone to carbon dioxide flushing with saline flush.

Inclusion Criteria:

• Elective TEVAR or TAVI
• Over 18 years old

Exclusion Criteria:

• Recent acute myocardial infarction
• Recent stroke or TIA
• Post or pending organ transplantation
• Active peptic ulcer disease
• Recent gastrointestinal bleed
• History of bleeding diathesis or coagulopathy or contraindications to antiplatelet or anticoagulant therapy.
• Permanent pacemaker or ICD
• History of atrial fibrillation
• Moderate or severe allergy to iodinated contrast not amenable to predmedication
• Renal failure
• Unable to safely undergo MRI
• Enrollment in another study