Transcarotid versus trans-axillary/subclavian transcatheter aortic valve replacement (TAVR): A systematic review and meta-analysis

被引:0
作者
Dawadi, Sagun [1 ]
Oli, Prakash Raj [2 ]
Shrestha, Dhan Bahadur [3 ]
Shtembari, Jurgen [3 ]
Pant, Kailash [4 ]
Shrestha, Bishesh [5 ]
Mattumpuram, Jishanth [6 ]
Katz, Daniel H. [5 ]
机构
[1] Nepalese Army Inst Hlth Sci, Dept Internal Med, Kathmandu 44600, Nepal
[2] Prov Hosp, Dept Internal Med, Surkhet 21700, Karnali, Nepal
[3] Mt Sinai Hosp, Dept Internal Med, Chicago, IL 60608 USA
[4] Univ Illinois, Dept Internal Med, Div Cardiovasc Med, OSF Healthcare,Coll Med, Peoria, IL 61614 USA
[5] Bassett Med Ctr, Dept Internal Med, Div Cardiol, 1 Atwell Rd, Cooperstown, NY 13326 USA
[6] Univ Louisville, Dept Internal Med, Div Cardiol, Sch Med, 550 S Jackson St, Louisville, KY 40202 USA
关键词
Transcatheter aortic valve replacement; Transcarotid TAVR; Trans-axillary/subclavian TAVR; ACCESS; DISTURBANCES; IMPLANTATION;
D O I
10.1016/j.cpcardiol.2024.102488
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Transcatheter Aortic Valve Replacement (TAVR) is the treatment of choice in patients with severe aortic stenosis. Transcarotid (TCa) or Trans-axillary/subclavian (TAx/Sc) are safer and less invasive non-femoral approaches, where transfemoral access is difficult or impossible to obtain. Methods: This meta-analysis was performed based on PRISMA guidelines after registering in PROSPERO (CRD42023482842). This meta-analysis was performed to compare the safety of the transcarotid and trans-axillary/subclavian approach for TAVR including studies from inception to October 2023. Results: Seven studies with a total of 6227 patients were included in the analysis (TCa: 2566; TAx/ Sc: 3661). Transcarotid TAVR approach had a favorable trend for composite of stroke and allcause mortality (OR 0.79, CI 0.60-1.04), all-cause mortality, stroke, major vascular complication, and new requirement of permanent pacemaker though those were statistically insignificant. On sub-analysis of the results of the studies based on the territory (USA vs French), composite outcome of all cause mortality, stroke and major bleeding (OR 0.54, CI 0.54-0.81), composite of stroke and all cause mortality (OR 0.64, CI 0.50-0.81), and stroke/TIA (OR 0.53, CI 0.39-0.73) showed lower odds of occurrence among patient managed with TCa approach in the American cohort. Conclusion: Overall, transcarotid approach had favorable though statistically insignificant odds for composite (stroke and all-cause mortality) and individual outcomes (stroke, all-cause mortality, etc.). There are significant variations in observed outcomes based on study's geographic location. Large prospective randomized clinical trials comparing the two approaches with representative samples are necessary to guide the clinicians in choosing among these approaches.
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页数:12
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