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Yamani N, Ali SH, Sadiq M, Ahmed AB, Bhojwani KD, Lohana VP, Fatmah S, Khalid S, Shamsi HR, Zehra B, Fatima K, Baloch ZQ. Trans-femoral versus trans-carotid access for transcatheter aortic valve replacement: an updated systematic review and meta-analysis. Future Sci OA 2024; 10:FSO930. [PMID: 38817364 PMCID: PMC11137775 DOI: 10.2144/fsoa-2023-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/27/2023] [Indexed: 06/01/2024] Open
Abstract
Aim: This meta-analysis aims to shed light on any primacy the trans-carotid (TC-TAVR) access may have over the trans-femoral access (TF-TAVR) for those undergoing transcatheter aortic valve replacement (TAVR). Methods: PubMed/MEDLINE and Cochrane Library were searched, from inception to March 2023 retrieving seven adjusted studies with a total of 6609 patients, of which 5048 underwent TF-TAVR while 1561 underwent TC-TAVR. Results: No divergence in risk of mortality, major bleeding or stroke/transient ischemic attack in TC-TAVR when compared with TF-TAVR was found. In TC-TAVR, the risk of vascular complications was low (OR: 0.51, 95% CI: 0.32-0.83, p = 0.003) as compared with TF-TAVR. Conclusion: As of this analysis, the viability of TC-TAVR as first alternative to TF-TAVR is plausible.
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Affiliation(s)
- Naser Yamani
- Division of Cardiology, University of Arizona Phoenix Medical Center, AZ 85721, USA
| | - Syed Hasham Ali
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Mahnoor Sadiq
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Afeera B Ahmed
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Kapil D Bhojwani
- Faculty of Medicine, Dow International Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Vivek P Lohana
- Faculty of Medicine, Dow International Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Saba Fatmah
- Faculty of Medicine, Karachi Medical & Dental College, Karachi, 74700, Pakistan
| | - Shazra Khalid
- Faculty of Medicine, Sindh Medical College, Jinnah Sindh Medical University, Karachi, 75510, Pakistan
| | - Hammad R Shamsi
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Batool Zehra
- Faculty of Medicine, Karachi Medical & Dental College, Karachi, 74700, Pakistan
| | - Kaneez Fatima
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Zulfiqar Q Baloch
- Division of Cardiology, Sparrow Hospital, Michigan State University, MI 48912, USA
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Yokoyama Y, Sakata T, Mikami T, Misumida N, Scotti A, Takagi H, Sugiura T, Kuno T, Latib A. Vascular access for transcatheter aortic valve replacement: A network meta-analysis. J Cardiol 2023; 82:227-233. [PMID: 37116649 DOI: 10.1016/j.jjcc.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/13/2023] [Accepted: 04/06/2023] [Indexed: 04/30/2023]
Abstract
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 outcomes 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.
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Affiliation(s)
- Yujiro Yokoyama
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Tomoki Sakata
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Takahisa Mikami
- Department of Neurology, Tufts Medical Center, Medford and Somerville, MA, USA
| | - Naoki Misumida
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, USA
| | - Andrea Scotti
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shimizu, Shizuoka, Japan
| | - Tadahisa Sugiura
- Department of Cardiothoracic & Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Toshiki Kuno
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Szotek M, Drużbicki Ł, Sabatowski K, Amoroso GR, De Schouwer K, Matusik PT. Transcatheter Aortic Valve Implantation and Cardiac Conduction Abnormalities: Prevalence, Risk Factors and Management. J Clin Med 2023; 12:6056. [PMID: 37762995 PMCID: PMC10531796 DOI: 10.3390/jcm12186056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Over the last decades, transcatheter aortic valve implantation (TAVI) or replacement (TAVR) has become a potential, widely accepted, and effective method of treating aortic stenosis in patients at moderate and high surgical risk and those disqualified from surgery. The method evolved what translates into a noticeable decrease in the incidence of complications and more beneficial clinical outcomes. However, the incidence of conduction abnormalities related to TAVI, including left bundle branch block and complete or second-degree atrioventricular block (AVB), remains high. The occurrence of AVB requiring permanent pacemaker implantation is associated with a worse prognosis in this group of patients. The identification of risk factors for conduction disturbances requiring pacemaker placement and the assessment of their relation to pacing dependence may help to develop methods of optimal care, including preventive measures, for patients undergoing TAVI. This approach is crucial given the emerging evidence of no worse outcomes for intermediate and low-risk patients undergoing TAVI in comparison to surgical aortic valve replacement. This paper comprehensively discusses the mechanisms, risk factors, and consequences of conduction abnormalities and arrhythmias, including AVB, atrial fibrillation, and ventricular arrhythmias associated with aortic stenosis and TAVI, as well as provides insights into optimized patient care, along with the potential of conduction system pacing and cardiac resynchronization therapy, to minimize the risk of unfavorable clinical outcomes.
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Affiliation(s)
- Michał Szotek
- Department of Electrocardiology, The John Paul II Hospital, 80 Prądnicka St., 31-202 Kraków, Poland
| | - Łukasz Drużbicki
- Department of Cardiovascular Surgery and Transplantology, The John Paul II Hospital, 80 Prądnicka St., 31-202 Kraków, Poland
| | - Karol Sabatowski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Kraków, Poland
| | - Gisella R. Amoroso
- Department of Cardiovascular Medicine, “SS Annunziata” Hospital, ASL CN1-Savigliano, Via Ospedali 9, 12038 Savigliano, Italy
| | - Koen De Schouwer
- Department of Cardiology, Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Paweł T. Matusik
- Department of Electrocardiology, The John Paul II Hospital, 80 Prądnicka St., 31-202 Kraków, Poland
- Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 80 Prądnicka St., 31-202 Kraków, Poland
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Ranka S, Lahan S, Chhatriwalla AK, Allen KB, Chiang M, O'Neill B, Verma S, Wang DD, Lee J, Frisoli T, Eng M, Bagur R, O'Neill W, Villablanca P. Network meta-analysis comparing the short and long-term outcomes of alternative access for transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:1-10. [PMID: 34972667 DOI: 10.1016/j.carrev.2021.11.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Several studies have pair-wise compared access sites for transcatheter aortic valve replacement (TAVR) but pooled estimate of overall comparative efficacy and safety outcomes are not well known. We sought to compare short- and long-term outcomes following various alternative access routes for TAVR. METHODS Thirty-four studies with a pooled sample size of 32,756 patients were selected by searching PubMed and Cochrane library databases from inception through 11th June 2021 for patients undergoing TAVR via 1 of 6 different access sites: Transfemoral (TF), Transaortic (TAO), Transapical (TA), Transcarotid (TC), Transaxillary/Subclavian (TSA), and Transcaval (TCV). Data were extracted to conduct a frequentist network meta-analysis with a random-effects model using TF access as a reference group. RESULTS Compared with TF, both TAO [RR 1.91, 95% CI (1.46-2.50)] and TA access [RR 2.12, 95% CI (1.84-2.46)] were associated with an increased risk of 30-day mortality. No significant difference was observed for stroke, myocardial infarction, major bleeding, conversion to open surgery, and major adverse cardiovascular or cerebrovascular events at 30 days between different accesses. Major vascular complications were lower in TA [RR 0.43, (95% CI, 0.28-0.67)] and TC [RR 0.51, 95% CI (0.35-0.73)] access compared to TF. The 1-year mortality was higher in TAO [RR of 1.35, (95% CI, 1.01-1.81)] and TA [RR 1.44, (95% CI, 1.14-1.81)] groups. CONCLUSION Non-thoracic alternative access site utilization for TAVR implantation (TC, TSA and TCV) is associated with outcomes similar to conventional TF access. Thoracic TAVR access (TAO and TA) translates into increased short and long-term mortality.
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Affiliation(s)
- Sagar Ranka
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Shubham Lahan
- Division of Cardiovascular Prevention & Wellness, Department of Cardiology, Houston Methodist, Houston, TX, United States
| | - Adnan K Chhatriwalla
- Department of Cardiothoracic Surgery, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, United States
| | - Keith B Allen
- Department of Cardiothoracic Surgery, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, United States
| | - Michael Chiang
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Brian O'Neill
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Sadhika Verma
- Department of Family Medicine, Henry Ford Allegiance Health, Jackson, MI, United States
| | - Dee Dee Wang
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - James Lee
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Tiberio Frisoli
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Marvin Eng
- Department of Cardiology, Banner University Medical Center, Phoenix, AZ, United States
| | - Rodrigo Bagur
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - William O'Neill
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Pedro Villablanca
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States.
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Lu H, Monney P, Hullin R, Fournier S, Roguelov C, Eeckhout E, Rubimbura V, Faroux L, Barrier A, Muller O, Kirsch M. Transcarotid Access Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:687168. [PMID: 34124210 PMCID: PMC8190826 DOI: 10.3389/fcvm.2021.687168] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/12/2021] [Indexed: 01/15/2023] Open
Abstract
Background: The transfemoral (TF) route is the gold-standard access for transcatheter aortic valve replacement (TAVR). In 10–15% of patients, alternative accesses are needed, such as the transcarotid (TC) access. We performed a meta-analysis to compare 30-day mortality and complications between TC-TAVR and TF-TAVR. Methods: We searched PubMed/MEDLINE and EMBASE from inception to January 2021 to identify articles comparing TC-TAVR and TF-TAVR. Patients' baseline characteristics, procedural outcomes, and clinical 30-day outcomes were extracted. Results: We identified 9 studies, among which 2 used propensity-score matching, including 1,374 TC patients and 3,706 TF patients. TC-TAVR was associated with significantly higher EuroSCORE II and Logistic EuroSCORE values (respectively 8.0 ± 6.7 vs. 6.3 ± 5.4, p = 0.002 and 20.8 ± 14.2% vs. 20.0 ± 13.4%, p = 0.04), a higher prevalence of peripheral artery disease (52.6 vs. 32.8%, p = 0.001), previous cardiac surgery (26.3 vs. 22.4%, p = 0.008) and coronary artery disease (64.6 vs. 60.5%, p = 0.020). The pooled results found TC-TAVR to be associated with a significantly higher 30-day mortality risk (RR, 1.41, 95% CI, 1.02–1.96, p = 0.040), and a lower rate of 30-day major vascular complications (RR, 0.48, 95% CI, 0.25–0.92, p = 0.030). No significant difference was found regarding permanent pacemaker implantation, major bleeding and acute kidney injury. A subgroup analysis of the two propensity-score matched studies found a statistically increased risk of 30-day neurovascular complications (RR, 1.61, 95% CI, 1.02–2.55, p = 0.040). Conclusion: Compared with TF-TAVR, TC-TAVR was associated with an increased risk of 30-day mortality, likely related to a higher surgical risk and comorbidity burden, and with an increased risk of 30-day neurovascular complications. Careful preprocedural patient selection and close periprocedural neurological monitoring are paramount.
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Affiliation(s)
- Henri Lu
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre Monney
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Roger Hullin
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stephane Fournier
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christian Roguelov
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eric Eeckhout
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Vladimir Rubimbura
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laurent Faroux
- Cardiology Department, Reims University Hospital, Reims, France
| | - Adelin Barrier
- Service of Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- Service of Cardiovascular Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Hudziak D, Hajder A, Gocol R, Malinowski M, Kazmierski M, Morkisz L, Ciosek J, Wanha W, Jarosinski G, Parma R, Darocha T, Wojakowski W. Long-Term Clinical Outcomes and Carotid Ultrasound Follow-Up of Transcarotid TAVI. Prospective Single-Center Registry. J Clin Med 2021; 10:1499. [PMID: 33916515 PMCID: PMC8038472 DOI: 10.3390/jcm10071499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to prospectively evaluate the safety and long-term clinical outcomes of cerebral-oximetry-guided transcarotid transcatheter aortic valve implantation (TC-TAVI) with systematic follow-up with carotid ultrasound. Thirty-three TCTAVI procedures were performed in our center from 2017 to 2019. Our analysis includes in-hospital outcomes and long-term follow-up data on mortality, echocardiographic parameters, carotid Doppler ultrasound, and VARC-2 defined clinical events. Intraoperatively, one patient died, and one had a transient ischemic attack (TIA). The following events occurred in-hospital postoperatively: myocardial infarction (3.0%), cardiac tamponade (3.0%), new-onset atrial fibrillation (6.3%), need for temporary pacing (27.3%) and need for pacemaker implantation (15%). The mean follow-up was 19.5 ± 9.52 months. In the long-term follow-up, the two-year survival rate was 83% ± 14. The echocardiographic parameters did not differ significantly from the postprocedural values, and the ultrasound did not show any cases of significant vessel narrowing. The mean peak systolic velocity (PSV) was 71.6 cm/s in the left common carotid artery and 70.6 cm/s in the right common carotid artery. In conclusion, cerebral oximetry-guided TC access is safe, has a favorable long-term outcome, and does not increase the risk of plaque formation in the carotid artery. In a carefully selected group of patients, it might be considered as a first-choice alternative to TF access.
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Affiliation(s)
- Damian Hudziak
- Department of Cardiac Surgery, Medical University of Silesia, 40-007 Katowice, Poland; (R.G.); (M.M.); (L.M.)
| | - Adrianna Hajder
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
| | - Radoslaw Gocol
- Department of Cardiac Surgery, Medical University of Silesia, 40-007 Katowice, Poland; (R.G.); (M.M.); (L.M.)
| | - Marcin Malinowski
- Department of Cardiac Surgery, Medical University of Silesia, 40-007 Katowice, Poland; (R.G.); (M.M.); (L.M.)
| | - Maciej Kazmierski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
| | - Lukasz Morkisz
- Department of Cardiac Surgery, Medical University of Silesia, 40-007 Katowice, Poland; (R.G.); (M.M.); (L.M.)
| | - Joanna Ciosek
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
| | - Wojciech Wanha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
| | - Grzegorz Jarosinski
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, 40-007 Katowice, Poland;
| | - Radoslaw Parma
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
| | - Tomasz Darocha
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, 40-007 Katowice, Poland;
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
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