Outcomes and Safety of Transcaval Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-analysis.

Autor: Salihu A; Division of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland., Ferlay C; Division of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Adult Intensive Care Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Division of Cardiac Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland., Kirsch M; Division of Cardiac Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland., Shah PB; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Skali H; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Fournier S; Division of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland., Meier D; Division of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland., Muller O; Division of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland., Hugelshofer S; Division of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland., Skalidis I; Division of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland., Tzimas G; Division of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland., Monney P; Division of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland., Eeckhout E; Division of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland., Arangalage D; Division of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Cardiology Department, AP-HP, Bichat Hospital and Université de Paris, Paris, France., Rancati V; Division of Anaesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland., Antiochos P; Division of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland., Lu H; Division of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: henri.lu@chuv.ch.
Jazyk: angličtina
Zdroj: The Canadian journal of cardiology [Can J Cardiol] 2024 May 24. Date of Electronic Publication: 2024 May 24.
DOI: 10.1016/j.cjca.2024.05.016
Abstrakt: Background: The transcaval (TCv) vascular approach is increasingly used in transcatheter aortic valve replacement (TAVR) in patients unsuitable for the gold-standard transfemoral approach. We aimed to evaluate the efficacy, safety, and clinical outcomes associated with TCv-TAVR.
Methods: A systematic review and meta-analysis was conducted by searching PubMed/Medline, Embase, and the Cochrane Library for all articles assessing the TCv approach published through December 2023. Outcomes included 30-day and 1-year all-cause mortality (ACM), 30-day rehospitalisation, perioperative complications and postoperative complications at 30 days. The meta-analysis was registered on the PROSPERO database with the identifier CRD42024501921.
Results: A total of 8 studies with 467 patients were included. TCv-TAVR procedures achieved a success rate of 98.5%. TCv-TAVR was associated with a 30-day ACM rate of 6.1% (95% confidence interval [CI]: 3.9%-8.2%), a 1-year ACM rate of 14.9% (95% CI 2.3%-27.6%) and a 30-day rehospitalisation rate of 4.2% (95% CI -2.2% to 10.6%). Postoperative stroke or transient ischemic attack, major vascular complications, and major or life-threatening bleeding occurred in 3.3%, 8.7%, and 7.5% of cases, respectively. Cumulative meta-analyses showed a temporal trend of decreasing rates of vascular complications.
Conclusions: The TCv approach in TAVR demonstrated a reassuring efficacy and safety profile, with mortality and postoperative complication rates similar to those reported for supra-aortic alternative TAVR access routes. The temporal decrease in vascular complications suggests potential improvements in procedural techniques and device technology. These findings further support the TCv approach as a viable option in patients ineligible for the transfemoral access.
Prospero: CRD42024501921.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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