Meta-analysis Comparing Transradial Versus Transfemoral Secondary Access in Transcatheter Aortic Valve Implantation.

Autor: Jhand A; Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska., Apala DR; Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska., Dhawan R; Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska., Katta N; Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska., Aronow HD; Warren Alpert Medical School, Brown University, and Lifespan Cardiovascular Institute, Providence, Rhode Island., Daniels MJ; Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, United Kingdom., Porter TR; Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska., Altin E; Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut., Goldsweig AM; Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska. Electronic address: andrew.goldsweig@unmc.edu.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2020 Sep 15; Vol. 131, pp. 74-81. Date of Electronic Publication: 2020 Jun 28.
DOI: 10.1016/j.amjcard.2020.06.032
Abstrakt: Up to a quarter of vascular complications during transcatheter aortic valve implantation (TAVI) result from secondary access via the femoral artery (FA). The radial artery (RA) is increasingly used as an alternative to the FA for secondary access in TAVI. Limited data exist on the outcomes of RA secondary access versus FA secondary access. We therefore conducted a systematic review and meta-analysis comparing secondary access sites. PubMed, EMBASE, Scopus, Cochrane library and CINAHL were searched systematically for studies comparing RA and FA as secondary access sites for TAVI. Primary outcomes of interest were vascular complications and major bleeding. Secondary outcomes included all-cause mortality, stroke and myocardial infarction (MI). Risk ratio (RR), standardized mean difference and corresponding 95% confidence intervals (CI) were calculated using a random effects model. Six observational studies comprising 6,373 patients (RA: 1,514, FA: 4,859) met inclusion criteria. Secondary access was utilized for aortography during valve deployment and to manage primary access site complications. Procedural characteristics were similar in both groups. RA was associated with a lower risk of major bleeding (RR: 0.51, 95% CI: 0.40 to 0.64, p <0.00001). No statistically significant difference was observed in the incidence of overall vascular complications, however, the risk of major vascular complications was lower with RA (RR: 0.45, 95% CI: 0.32 to 0.63, p <0.00001). The incidence of stroke and all-cause mortality was lower in RA, whereas no difference was observed in the risk of MI. In conclusion, our meta-analysis suggests that RA secondary access is associated with better outcomes for TAVI than FA.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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