Vascular access for transcatheter aortic valve replacement: A network meta-analysis

被引：7

作者：

Yokoyama, Yujiro ^{[1
]}

Sakata, Tomoki ^{[2
]}

Mikami, Takahisa ^{[3
,4
]}

Misumida, Naoki ^{[5
]}

Scotti, Andrea ^{[6
]}

Takagi, Hisato ^{[7
]}

Sugiura, Tadahisa ^{[8
]}

Kuno, Toshiki ^{[9
]}

Latib, Azeem ^{[6
]}

机构：

[1] St Lukes Univ Hlth Network, Dept Surg, Bethlehem, PA USA

[2] Icahn Sch Med Mt Sinai, Cardiovasc Res Inst, New York, NY USA

[3] Tufts Med Ctr, Dept Neurol, Boston, MA USA

[4] Tufts Med Ctr, Dept Neurol, Somerville, MA USA

[5] Univ Kentucky, Gill Heart & Vasc Inst, Div Cardiovasc Med, Lexington, KY USA

[6] Montefiore Med Ctr, Albert Einstein Coll Med, Dept Cardiol, Bronx, NY 10467 USA

[7] Shizuoka Med Ctr, Dept Cardiovasc Surg, Shimizu, Shizuoka, Japan

[8] Montefiore Med Ctr, Albert Einstein Coll Med, Dept Cardiothorac & Vasc Surg, Bronx, NY 10467 USA

[9] Montefiore Med Ctr, Albert Einstein Coll Med, Div Cardiol, 111 East 210th St, Bronx, NY 10467 USA

来源：

JOURNAL OF CARDIOLOGY | 2023年 / 82卷 / 04期

关键词：

Transcatheter aortic valve replacement; Transfemoral; Trans-subclavian; Transcarotid; Transcaval; SUBCLAVIAN/AXILLARY ACCESS; CLINICAL-OUTCOMES; TRANSCAVAL ACCESS; TERM OUTCOMES; IMPLANTATION; COREVALVE; ROUTE; TAVI; EFFICACY; INJURY;

D O I：

10.1016/j.jjcc.2023.04.015

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: The choice of an alternative access for transcatheter aortic valve replacement (TAVR) remains controversial when transfemoral (TF) access is not feasible. Methods: We conducted a network meta-analysis to compare the outcomes of TAVR via various peripheral vascular accesses. MEDLINE and EMBASE were searched through July 2022 to identify studies that investigated out-comes in patients who underwent TAVR via TF, trans-subclavian (Tsc), transcarotid (TC), or transcaval (Tcav) access. A network meta-analysis was conducted via random-effects model. Outcomes of interest were major or life-threatening bleeding, stroke, major vascular complication, and 30-day mortality. Results: No randomized trial was identified. Our analysis included 33 observational studies that enrolled a total of 43,455 patients who underwent TAVR via TF (n = 36,202), Tsc (n = 3869), TC (n = 3066), or Tcav (n = 318) access. The risk of major or life-threatening bleeding was higher via Tsc compared with TF [odds ratio (OR); 95 % confidence interval (CI) =1.51 (1.03-2.23), p = 0.034]. The risk of stroke was higher via Tsc compared with TF and Tcav [OR (95 % CI) =2.00 (1.14-3.52), p = 0.018, OR (95 % CI) =2.43 (1.03-5.74), p = 0.044, respectively]. The risk of major vascular complications was lower via TC compared with Tsc, and Tcav and higher with Tcav compared with TF and Tsc. 30-day mortality was higher via Tsc compared with TF. Tsc was associated with higher risk of major or life-threatening bleeding compared with TF, and higher risk of stroke compared to TF and Tcav. Tcav had the highest risk of major vascular complications. Conclusion: In patients who underwent TF, Tsc, TC, or Tcav TAVR, Tsc had a higher rate of stroke compared to TF and Tcav, and major or life-threatening bleeding compared to TF. The rate of major vascular complications in Tcav was the highest among the four approaches.& COPY; 2023 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

引用

页码：227 / 233

页数：7

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