scholarly journals Dose approach matter? A meta-analysis of outcomes following transfemoral versus transapical transcatheter aortic valve replacement

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ruikang Guo ◽  
Minghui Xie ◽  
Wai Yen Yim ◽  
Wenconghui Wu ◽  
Weiwei Jiang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Observational Studies ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Vascular Complication ◽  
Permanent Pacemaker ◽  
Transcatheter Aortic Valve ◽  
Effect Model

Abstract Background Transcatheter aortic valve replacement (TAVR) has gained increasing acceptance for patients with aortic disease. Both transfemoral (TF-TAVR) and transapical (TA-TAVR) approach were widely adopted while their performances are limited to a few studies with controversial results. This meta-analysis aimed to compare the mortality and morbidity of complications between TF- versus TA-TAVR based on the latest data. Methods Electronic databases were searched until April 2021. RCTs and observational studies comparing the outcomes between TF-TAVR versus TA-TAVR patients were included. Heterogeneity assumption was assessed by an I2 test. The pooled odds ratios(OR) or mean differences with corresponding 95% confidence intervals (CI) were used to evaluate the difference for each end point using a fixed-effect model or random-effect model based on I2 test. Results The meta-analysis included 1 RCT and 20 observational studies, enrolling 19,520 patients (TF-TAVR, n = 11,986 and TA-TAVR, n = 7,534). Compared with TA-TAVR, TF-TAVR patients showed significantly lower rate of postoperative in-hospital death (OR = 0.67, 95% CI 0.59–0.77, P < 0.001) and 1-year death (OR = 0.53, 95% CI 0.41–0.69, P < 0.001). Incidence of major bleeding and acute kidney injury were lower and length of hospital stay was shorter, whereas those of permanent pacemaker and major vascular complication were higher in TF-TAVR patients. There were no significant differences between TF-TAVR versus TA-TAVR for stroke and mid-term mortality. Conclusions There were fewer early deaths in patients with transfemoral approach, whereas the number of mid-term deaths and stroke was not significantly different between two approaches. TF-TAVR was associated with lower risk of bleeding, acute kidney injury as well as shorter in-hospital stay, but higher incidence of vascular complication and permanent pacemaker implantation.

scholarly journals Dose approach matter?A Meta-analysis of outcomes following transfemoral versus transapical transcatheter aortic valve replacement

2020 ◽  
Author(s):  
Ruikang Guo ◽  
Minghui Xie ◽  
Wai Yen Yim ◽  
Wenconghui Wu ◽  
Weiwei Jiang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Observational Studies ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Vascular Complication ◽  
Permanent Pacemaker ◽  
Transcatheter Aortic Valve ◽  
Effect Model

Abstract Background: Transcatheter aortic valve replacement (TAVR) has gained increasing acceptance for patients with aortic disease. Both transfemoral (TF-TAVR) and transapical (TA-TAVR) approach were widely adopted while their performances are limited to a few studies with controversial results. This meta-analysis aimed to compare the mortality and morbidity of complications between TF- versus TA-TAVR based on the latest data. Methods: Electronic databases were searched from January 2005 to December 2019. RCTs and observational studies comparing the outcomes between TF-TAVR versus TA-TAVR patients were included. Heterogeneity assumption was assessed by an I2 test. The pooled odds ratios(OR) or mean differences with corresponding 95% confidence intervals (CI) were used to evaluate the difference for each end point using a fixed-effect model or random-effect model based on I2 test. Results: The meta-analysis included 1 RCT and 18 observational studies, enrolling 12,953 patients (TF-TAVR, n=8,649 and TA-TAVR, n=4,304). Compared with TA-TAVR, TF-TAVR patients showed significantly lower rate of postoperative in-hospital death (OR=0.63, 95%CI 0.54-0.74, P<0.001) and 1-year death(OR=0.53, 95%CI 0.41-0.69, P<0.001). Incidence of major bleeding and acute kidney injury were lower, whereas those of permanent pacemaker and major vascular complication were higher in TF-TAVR patients. There were no significant differences between TF-TAVR versus TA-TAVR for stroke and mid-term mortality.Conclusions: There were fewer early deaths in patients with transfemoral approach, whereas the number of mid-term deaths and stroke was not significantly different between two approaches. TF-TAVR was associated with lower risk of bleeding, acute kidney injury as well as shorter in-hospital stay, but higher incidence of vascular complication and permanent pacemaker implantation.

Acute Kidney Injury after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

2015 ◽  
Vol 41 (4-5) ◽  
pp. 372-382 ◽  
Author(s):  
Charat Thongprayoon ◽  
Wisit Cheungpasitporn ◽  
Narat Srivali ◽  
Patompong Ungprasert ◽  
Wonngarm Kittanamongkolchai ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Acute Kidney Injury ◽  
Aortic Valve ◽  
Propensity Score ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Transcatheter Aortic Valve

Background: The objective of this meta-analysis was to evaluate the risk of acute kidney injury (AKI) in patients who underwent transcatheter aortic valve replacement (TAVR). Methods: A literature search was performed using MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews and clinicaltrials.gov from inception through October, 2014. Studies that reported relative risks, ORs, or hazard ratios comparing the AKI risk in patients who underwent TAVR versus those who underwent surgical aortic valve replacement were included. We performed the pre-specified sensitivity analysis including only propensity score-based studies. Mortality risk was evaluated among the studies that reported AKI outcome. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Results: Three randomized controlled trials (RCTs) with 1,852 patients and 14 cohort studies with 3,113 patients were analyzed to assess the AKI risk in patients undergoing TAVR. The pooled RRs of AKI in patients undergoing TAVR were 0.65 (95% CI 0.36-1.15, I2 = 75%) in the analysis of RCTs and propensity score-based studies and 0.76 (95% CI 0.44-1.34, I2 = 79%) in the analysis of observational studies. Sensitivity analysis in RCTs and propensity score-based studies using a standard AKI definition demonstrated a significant association between TAVR and lower AKI risk (RR 0.35, 95% CI 0.25-0.50, I2 = 0%). Our meta-analyses of RCTs and propensity score-based studies did not find associations between TAVR and reduced risks of severe AKI requiring dialysis (RR 0.82, 95% CI 0.38-1.79, I2 = 63%). Conclusions: Our meta-analysis demonstrates an association between TAVR and lower AKI risk.

scholarly journals Association of frailty status with acute kidney injury and mortality after transcatheter aortic valve replacement: A systematic review and meta-analysis

PLoS ONE ◽  
2017 ◽  
Vol 12 (5) ◽  
pp. e0177157 ◽  
Author(s):  
Charat Thongprayoon ◽  
Wisit Cheungpasitporn ◽  
Natanong Thamcharoen ◽  
Patompong Ungprasert ◽  
Wonngarm Kittanamongkolchai ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Frailty Status ◽  
Transcatheter Aortic Valve

scholarly journals Minimally invasive surgery versus transcatheter aortic valve replacement: a systematic review and meta-analysis

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001535
Author(s):  
Ahmed Sayed ◽  
Salma Almotawally ◽  
Karim Wilson ◽  
Malak Munir ◽  
Ahmed Bendary ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Paravalvular Leakage ◽  
Transcatheter Aortic Valve

Transcatheter aortic valve replacement (TAVR) has recently been approved for use in patients who are at intermediate and low surgical risk. Moreover, recent years have witnessed a renewed interest in minimally invasive aortic valve replacement (miAVR). The present meta-analysis compared the outcomes of TAVR and miAVR in the management of aortic stenosis (AS). We conducted an electronic search across six databases from 2002 (TAVR inception) to December 2019. Data from relevant studies regarding the clinical and length of hospitalisation outcomes were extracted and analysed using R software. We identified a total of 11 cohort studies, of which seven were matched/propensity matched. Our analysis demonstrated higher rates of midterm mortality (≥1 year) with TAVR (risk ratio (RR): 1.93, 95% CI: 1.16 to 3.22), but no significant differences with respect to 1 month mortality (RR: 1.00, 95% CI: 0.55 to 1.81), stroke (RR: 1.08, 95% CI: 0.40 to 2.87) and bleeding (RR: 1.45, 95% CI: 0.56 to 3.75) rates. Patients undergoing TAVR were more likely to experience paravalvular leakage (RR: 14.89, 95% CI: 6.89 to 32.16), yet less likely to suffer acute kidney injury (RR: 0.38, 95% CI: 0.21 to 0.69) compared with miAVR. The duration of hospitalisation was significantly longer in the miAVR group (mean difference: 1.92 (0.61 to 3.24)). Grading of Recommendations Assessment, Development and Evaluation assessment revealed ≤moderate quality of evidence in all outcomes. TAVR was associated with lower acute kidney injury rate and shorter length of hospitalisation, yet higher risks of midterm mortality and paravalvular leakage. Given the increasing adoption of both techniques, there is an urgent need for head-to-head randomised trials with adequate follow-up periods.

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