Percutaneous Versus Surgical Cutdown Access for Transfemoral Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis Focusing on Propensity-Score Matched Studies.

Autor: Riaz S; Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan., Kasam Shiva PK; Bangalore Medical College and Research Institute, Bangalore, India. Electronic address: pks6399@gmail.com., Manimekalai Krishnamurthi JS; Department of Medicine, Madras Medical College, Chennai, India., Shah RS; Department of Medicine, G.M.E.R.S. Medical College, Gandhinagar, India., Cherukuri AMK; Department of Medicine, Guntur Medical College, Guntur, India., Bhatia P; Seth GS Medical College and KEM Hospital, Mumbai, India., Arul S; University of Perpetual Help System DALTA Jonelta Foundation School of Medicine, Manila, Philippines., Multani M; Adesh Institute of Medical Sciences and Research, Punjab, India., Singh A; Government Medical College and Hospital, Chandigarh, India., Suyambu J; University of Perpetual Help System DALTA Jonelta Foundation School of Medicine, Manila, Philippines., Asif K; Department of Medicine, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Karachi, Pakistan., Al-Tawil M; Faculty of Medicine, Al-Quds University Jerusalem, Palestine.
Jazyk: angličtina
Zdroj: Heart, lung & circulation [Heart Lung Circ] 2024 Oct; Vol. 33 (10), pp. 1393-1403. Date of Electronic Publication: 2024 Aug 23.
DOI: 10.1016/j.hlc.2024.05.011
Abstrakt: Background: Transcatheter aortic valve implantation (TAVI) has emerged as a potential alternative for aortic valve surgery to treat aortic valve stenosis. There is limited evidence on the comparative outcomes of TAVI access approaches, specifically the percutaneous (PC) vs surgical cutdown (SC) approach. This study aimed to assess the short-term outcomes in patients undergoing PC vs SC access for transfemoral transcatheter aortic valve replacement.
Methods: PubMed, SCOPUS, and EMBASE were searched to identify relevant studies. The primary outcomes were short-term all-cause mortality, bleeding, vascular complications, and length of in-hospital stay for patients who underwent transfemoral TAVI. Both matched and unmatched observational studies were included and subgroup analyses were performed. This systematic review and meta-analysis was performed in line with the PRISMA guidelines.
Results: Fifteen observational studies involving 7,545 patients (3,033 underwent the PC approach and 2,466 underwent the SC approach) were included. There were no clinically significant between-group differences in short-term mortality, bleeding, length of in-hospital stay, or major vascular complications. However, minor vascular complications were significantly higher in patients who underwent PC-TAVI (p=0.007). In the matched subgroup, all outcomes were comparable between both groups, with the largest difference being observed in minor vascular complications more frequently occurring in the PC group (p=0.08).
Conclusion: The evidence shows that outcomes were comparable between the two methods of access, rendering both the PC and SC approaches equally effective for transfemoral TAVI. However, it is worth noting that minor vascular complications were more pronounced in the PC group.
Competing Interests: Conflict of Interest There is no conflict of interest to declare.
(Copyright © 2024 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.)
Databáze: MEDLINE
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