Transcarotid Access Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Background: The transfemoral (TF) route is the gold-standard access for transcatheter aortic valve replacement (TAVR). In 10–15% of patients, alternative accesses are needed, such as the transcarotid (TC) access. We performed a meta-analysis to compare 30-day mortality and complications between TC-TAVR and TF-TAVR.Methods: We searched PubMed/MEDLINE and EMBASE from inception to January 2021 to identify articles comparing TC-TAVR and TF-TAVR. Patients' baseline characteristics, procedural outcomes, and clinical 30-day outcomes were extracted.Results: We identified 9 studies, among which 2 used propensity-score matching, including 1,374 TC patients and 3,706 TF patients. TC-TAVR was associated with significantly higher EuroSCORE II and Logistic EuroSCORE values (respectively 8.0 ± 6.7 vs. 6.3 ± 5.4, p = 0.002 and 20.8 ± 14.2% vs. 20.0 ± 13.4%, p = 0.04), a higher prevalence of peripheral artery disease (52.6 vs. 32.8%, p = 0.001), previous cardiac surgery (26.3 vs. 22.4%, p = 0.008) and coronary artery disease (64.6 vs. 60.5%, p = 0.020). The pooled results found TC-TAVR to be associated with a significantly higher 30-day mortality risk (RR, 1.41, 95% CI, 1.02–1.96, p = 0.040), and a lower rate of 30-day major vascular complications (RR, 0.48, 95% CI, 0.25–0.92, p = 0.030). No significant difference was found regarding permanent pacemaker implantation, major bleeding and acute kidney injury. A subgroup analysis of the two propensity-score matched studies found a statistically increased risk of 30-day neurovascular complications (RR, 1.61, 95% CI, 1.02–2.55, p = 0.040).Conclusion: Compared with TF-TAVR, TC-TAVR was associated with an increased risk of 30-day mortality, likely related to a higher surgical risk and comorbidity burden, and with an increased risk of 30-day neurovascular complications. Careful preprocedural patient selection and close periprocedural neurological monitoring are paramount.

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

American Journal of Nephrology ◽

10.1159/000431337 ◽

2015 ◽

Vol 41 (4-5) ◽

pp. 372-382 ◽

Cited By ~ 28

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.

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Comparative efficacy and safety of antithrombotic therapy for transcatheter aortic valve replacement: a systematic review and network meta-analysis

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz335 ◽

2019 ◽

Vol 57 (5) ◽

pp. 965-976 ◽

Cited By ~ 1

Author(s):

Yuexin Zhu ◽

Ziyuan Zou ◽

Yusi Huang ◽

Lei Zhang ◽

Huiting Chen ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Antiplatelet Therapy ◽

Valve Replacement ◽

Antithrombotic Therapy ◽

Transcatheter Aortic Valve Replacement ◽

Meta Analysis ◽

Treatment Modalities ◽

Transcatheter Aortic Valve ◽

Increased Risk

Abstract OBJECTIVES We sought to determine the optimal antithrombotic therapy after transcatheter aortic valve replacement. METHODS Related scientific databases were searched until December 2018. We conducted a pairwise and a network meta-analysis within a frequentist framework, measuring 30-day bleeding, stroke and all-cause mortality. The surface under the cumulative ranking (SUCRA) curve was estimated to rank the therapies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was performed. The protocol was registered with PROSPERO (CRD42018111163). RESULTS Eight studies comprising 2173 patients were analysed. The risk of 30-day bleeding was higher for dual antiplatelet therapy (DAPT) than single antiplatelet therapy (SAPT) [odds ratio (OR) 1.90 (1.10–3.28); P = 0.02], whereas there was no difference in the risk of 30-day stroke [OR 1.27 (0.38–4.20); P = 0.69] and mortality [OR 1.46 (0.67–3.22); P = 0.34] between DAPT and SAPT. In the network meta-analysis, DAPT + oral anticoagulant (OAC) increased the risk of 30-day bleeding compared with SAPT [OR 6.21 (1.74–22.17); P = 0.005], DAPT [OR 3.27 (1.04–10.32); P = 0.043], SAPT + OAC [OR 4.87 (2.51–9.45); P < 0.001] and OAC [OR 14.4 (1.3–154.7); P = 0.028]. Additionally, patients receiving DAPT + OAC had the highest risks for 30-day bleeding (SUCRA 1.0%). OAC seemed to be superior to SAPT and DAPT in terms of 30-day bleeding (SUCRA OAC: 86.3%, SAPT: 72.3%, DAPT: 32.3%) and stroke (SUCRA 54.2%, 47.4%, 40.5%), but not mortality (SUCRA 69.6%, 74.1%, 43.4%). CONCLUSIONS There is a trend towards less bleeding with the application of SAPT, but no mortality benefit with the application of DAPT is shown. The comparison of SAPT, DAPT and OAC shows that OAC may improve the balance between stroke and bleeding, which can reduce the risk of mortality. In addition, the application of DAPT + OAC was ranked the worst amongst all treatment modalities and should be avoided due to an increased risk of bleeding. Clinical trial registration number PROSPERO (International Prospective Register of Systematic Reviews, CRD42018111163).

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Preprocedural circulating galectin-3 and the risk of mortality after transcatheter aortic valve replacement: a systematic review and meta-analysis

Bioscience Reports ◽

10.1042/bsr20202306 ◽

2020 ◽

Vol 40 (9) ◽

Author(s):

Hong-liang Zhang ◽

Guang-yuan Song ◽

Jie Zhao ◽

Yu-bin Wang ◽

Mo-yang Wang ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Meta Analysis ◽

Transcatheter Aortic Valve ◽

Increased Risk ◽

All Cause Mortality ◽

Galectin 3

Abstract Background: Galectin-3 may predict mortality for patients with aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR). However, the results were inconsistent. We aimed to evaluate the association between baseline galectin and mortality after TAVR in a meta-analysis. Methods: Related follow-up studies were obtained by systematic search of PubMed, Cochrane’s Library, and Embase databases. Both the fixed- and the random-effect models were used for the meta-analysis. Subgroup analyses were performed to evaluate the influences of study characteristics on the outcome. Results: Five prospective cohort studies with 854 patients were included, with a follow-up period between 1 and 1.9 years. Patients with higher baseline circulating galectin-3 had an increased risk of all-cause mortality after TAVR (random-effects model: risk ratio [RR]: 1.63, 95% confidence interval [CI]: 1.19–2.23, P=0.002; fixed-effects model: RR: 1.62, 95% CI: 1.19–2.20, P=0.002; I2 = 4%). Adjustment of estimated glomerular filtration rate (RR: 1.73, P=0.02) or B-type natriuretic peptide (BNP) or N-terminal pro-BNP (RR: 1.83, P=0.02) did not significantly affect the result. A trend of stronger association between higher baseline circulating galectin-3 and increased risk of all-cause mortality after TAVR was observed in studies with an enzyme-linked fluorescent assay (ELFA) (RR: 3.04, P=0.003) compared with those with an enzyme-linked immunosorbent assay (ELISA) (RR: 1.42, P=0.04; P for subgroup difference =0.06). Conclusion: Higher circulating galectin-3 before the procedure may predict all-cause mortality of AS patients after TAVR.

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Relationship between procedural characteristics and cerebrovascular events after transcatheter aortic valve replacement

Open Heart ◽

10.1136/openhrt-2018-000816 ◽

2018 ◽

Vol 5 (2) ◽

pp. e000816 ◽

Cited By ~ 1

Author(s):

Kashish Goel ◽

Vuyisile T Nkomo ◽

Joshua P Slusser ◽

Ryan Lennon ◽

Robert D Brown ◽

...

Keyword(s):

Aortic Valve ◽

Propensity Score ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Transcatheter Aortic Valve ◽

Increased Risk ◽

The Impact

ObjectivesThe objective was to assess the impact of procedural characteristics on risk of stroke or transient ischaemic attack (TIA) after transcatheter aortic valve replacement (TAVR).MethodsWe included 370 consecutive patients who underwent balloon-expandable TAVR from 1 November 2008 to 30 June 2014. Procedural characteristics that may be associated with stroke/TIA were assessed. The primary outcome was stroke/TIA at 30 days. A propensity score was constructed using a logistic regression model with 29 parameters. Cox proportional hazards models were used with a propensity score covariate.ResultsMean age was 80.9±7.9 years and mean Society of Thoracic Surgeons score was 8.3±5.0. The total number of balloon dilations ranged from 2 to 7. Out of 370 patients, 13 patients (3.5%) suffered stroke/TIA in the first 30 days after TAVR. In univariate analysis, postdeployment balloon dilation (PD) (HR 3.8, 95% CI 1.24 to 11.61; p=0.02) and emergent cardiopulmonary bypass (CPB) (HR 9.66, 95% CI 2.66 to 35.15; p<0.001) were significantly associated with 30-day stroke/TIA. In the multivariable Cox-proportional hazards model, PD (HR 4.95, 95% CI 1.02 to 24.03; p=0.04) and emergent CPB (HR 7.15, 95% CI 1.39 to 36.89; p=0.02) were independently associated with increased risk of 30-day stroke/TIA after adjusting for propensity score, total number of balloon dilations and periprosthetic regurgitation.ConclusionPostdilation as compared with total number of dilations, and emergent CPB were independently associated with increased risk of clinical neurological events in the first 30 days after TAVR. Reduction in balloon postdilation with appropriate valve sizing may reduce the risk of stroke or TIA after TAVR.

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Impact of Coronary Artery Disease on 30‐Day and 1‐Year Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement: A Meta‐Analysis

Journal of the American Heart Association ◽

10.1161/jaha.117.006092 ◽

2017 ◽

Vol 6 (10) ◽

Cited By ~ 25

Author(s):

Kesavan Sankaramangalam ◽

Kinjal Banerjee ◽

Krishna Kandregula ◽

Divyanshu Mohananey ◽

Akhil Parashar ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Meta Analysis ◽

Transcatheter Aortic Valve ◽

Artery Disease

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Femoral Versus Nonfemoral Subclavian/Carotid Arterial Access Route for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta‐Analysis

Journal of the American Heart Association ◽

10.1161/jaha.120.017460 ◽

2020 ◽

Vol 9 (19) ◽

Author(s):

Laurent Faroux ◽

Lucia Junquera ◽

Siamak Mohammadi ◽

David Del Val ◽

Guillem Muntané‐Carol ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Meta Analysis ◽

Vascular Complication ◽

Transfemoral Approach ◽

Arterial Access ◽

Transcatheter Aortic Valve ◽

Increased Risk

Background Some concerns remain regarding the safety of transcarotid and transsubclavian approaches for transcatheter aortic valve replacement. We aimed to compare the risk of 30‐day complications and death in transcarotid/transsubclavian versus transfemoral transcatheter aortic valve replacement recipients. Methods and Results Data from 20 studies, including 79 426 patients (16 studies) and 3992 patients (4 studies) for the evaluation of the unadjusted and adjusted impact of the arterial approach were sourced, respectively. The use of a transcarotid/transsubclavian approach was associated with an increased risk of stroke when using unadjusted data (risk ratio [RR], 2.28; 95% CI, 1.90–2.72) as well as adjusted data (odds ratio [OR], 1.53; 95% CI, 1.05–2.22). The pooled results deriving from unadjusted data showed an increased risk of 30‐day death (RR, 1.46; 95% CI, 1.22–1.74) and bleeding (RR, 1.53; 95% CI, 1.18–1.97) in patients receiving transcatheter aortic valve replacement through a transcarotid/transsubclavian access (compared with the transfemoral group), but the associations between the arterial access and death (OR, 1.22; 95% CI, 0.89–1.69), bleeding (OR, 1.05; 95% CI, 0.68–1.61) were no longer significant when using adjusted data. No significant effect of the arterial access on vascular complication was observed in unadjusted (RR, 0.84; 95% CI, 0.66–1.06) and adjusted (OR, 0.79; 95% CI, 0.53–1.17) analyses. Conclusions Transcarotid and transsubclavian approaches for transcatheter aortic valve replacement were associated with an increased risk of stroke compared with the transfemoral approach. However, these nonfemoral arterial alternative accesses were not associated with an increased risk of 30‐day death, bleeding, or vascular complication when taking into account the confounding factors.

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Abstract 15428: Network Meta-analysis of Duration of Antiplatelet Therapy Following Transcatheter Aortic Valve Replacement

Circulation ◽

10.1161/circ.142.suppl_3.15428 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Yujiro Yokoyama ◽

Toshiki Kuno ◽

Alexandros BRIASOULIS ◽

Makoto Mori ◽

Masao Iwagami ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Antiplatelet Therapy ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Meta Analysis ◽

Transcatheter Aortic Valve ◽

Increased Risk ◽

All Cause Mortality ◽

Life Threatening

Background: Although current guidelines recommend dual antiplatelet therapy (DAPT) for 3 to 6 months following transcatheter aortic valve replacement (TAVR), there are no studies directly comparing outcomes of different durations of DAPT following TAVR. Methods: Pubmed and EMBASE were searched through May, 2020 to identify clinical studies that investigated single antiplatelet therapy (SAPT) versus DAPT use following TAVR. Studies using oral anticoagulants and antiplatelet therapy concomitantly were excluded. The DAPT group was subdivided by the duration of DAPT. We extracted the risk ratios (RRs) of major or life-threatening bleeding, stroke, and all-cause mortality. Results: Three randomized controlled trials, two propensity-score matched studies, and one observational study were identified, yielding a total of 1,833 patients who underwent TAVR assigned to the SAPT group (n=918), 3-month DAPT group (n=151), or 6-month DAPT group (N=764). Pooled analyses demonstrated that the rates of major or life-threatening bleeding were significantly higher in the 6-month DAPT group compared with the SAPT group (RR [95% CI] =2.54 [1.49-4.33], P =0.007) while no such difference was observed between the SAPT vs. 3-month DAPT groups or the 3-month DAPT vs. 6-month DAPT groups (Figure). P-scores were 98.1% (SAPT), 32.3% (3-month DAPT), and 19.6% (6-month DAPT). The rates of stroke and all-cause mortality were similar among the groups. Conclusions: In our network meta-analysis, we observed that DAPT for 6 months following TAVR was associated with increased risk of bleeding without decreasing the risk of stroke compared with SAPT, while there was no difference between DAPT for 3 months and 6 months.

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