Transcaval access for transcatheter aortic valve implantation: A meta-analysis and systematic review.

Autor: Abraham B; Department of Cardiology, Mayo Clinic, Phoenix, AZ, United States of America. Electronic address: bisho.abraham@gmail.com., Sous M; Department of Medicine, Amita Health Saint Francis Hospital, Evanston, IL, United States of America., Kaldas S; Department of Cardiology, Mayo Clinic, Phoenix, AZ, United States of America., Nakhla M; Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, United States of America., Sweeney J; Department of Cardiology, Mayo Clinic, Phoenix, AZ, United States of America., Lee K; Department of Cardiology, Mayo Clinic, Phoenix, AZ, United States of America., Garcia S; Department of Cardiovascular Disease, The Christ Hospital, Cincinnati, OH, United States of America., Saad M; Lifespan Cardiovascular Institute and Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI, United States of America., Goel SS; Department of Cardiovascular Disease, Houston Methodist Hospital, Houston, TX, United States of America., Fortuin FD; Department of Cardiology, Mayo Clinic, Phoenix, AZ, United States of America.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2025 Jan 15; Vol. 419, pp. 132720. Date of Electronic Publication: 2024 Nov 12.
DOI: 10.1016/j.ijcard.2024.132720
Abstrakt: Background: Anatomical factors may preclude transfemoral (TF) arterial access for transcatheter aortic valve implantation (TAVI). Transcaval (TCav) access has been utilized as an alternative access for these patients. We aimed to investigate the outcomes of TCav access in patients undergoing TAVI.
Methods: We performed a systematic review and meta-analysis including all published studies from 1996 to November 2023 that examined TCav access in patients undergoing TAVI. The main outcomes included all cause mortality, major vascular complications, major bleeding, stroke, and myocardial infarction (MI). Outcomes were reported at 30-day and 1-year follow-up.
Results: We included 8 observational studies with a total of 517 patients (mean age 78.1±8 years, 56.6 % women, mean STS score 7 ± 4.5). Mean (SD) procedure time was 35 ± 9.8 mins and mean (SD) contrast volume was 136.3 ± 77.4 ml. Procedure success was achieved in 94.3 % of the patients. At 30-day follow-up, all-cause mortality occurred in 6.4 %, major bleeding in 12.2 %, blood transfusion in 23.3 %, retroperitoneal bleeding in 19 %, major vascular complications in 7.9 %, MI in 2.8 %, and AKI in 6.4 % of patients. At 1-year, all-cause mortality was 14.7 %. In a sub-group analysis including 3 studies comparing TCav (n = 316) to alternative accesses (including transcarotid, transaxillary, and transapical) (n = 303), there were no differences in all-cause mortality, major bleeding, major vascular complications, blood transfusion, or stroke at 30-day.
Conclusion: Transcaval approach is feasible and non-inferior to other alternative accesses in TAVI patients with prohibitive iliofemoral anatomy.
Competing Interests: Declaration of competing interest All authors have nothing to disclose.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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