Percutaneous Versus Surgical Cutdown Access for Transfemoral Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis Focusing on Propensity-Score Matched Studies
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 s...
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Published in | Heart, lung & circulation Vol. 33; no. 10; pp. 1393 - 1403 |
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Main Authors | , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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Elsevier B.V
01.10.2024
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Abstract | 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.
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.
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).
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. |
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AbstractList | 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.
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.
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).
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. 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.BACKGROUNDTranscatheter 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.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.METHODSPubMed, 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.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).RESULTSFifteen 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).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.CONCLUSIONThe 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. |
Author | Bhatia, Pranav Manimekalai Krishnamurthi, Jaya Surya Kasam Shiva, Pavan Kumara Cherukuri, Anjani Mahesh Kumar Shah, Roopshri Sunilkumar Arul, Subiksha Suyambu, Jenisha Al-Tawil, Mohammed Asif, Kainat Multani, Monika Riaz, Sania Singh, Adishwar |
Author_xml | – sequence: 1 givenname: Sania orcidid: 0009-0001-6585-6120 surname: Riaz fullname: Riaz, Sania organization: Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan – sequence: 2 givenname: Pavan Kumara orcidid: 0009-0007-0976-6183 surname: Kasam Shiva fullname: Kasam Shiva, Pavan Kumara email: pks6399@gmail.com organization: Bangalore Medical College and Research Institute, Bangalore, India – sequence: 3 givenname: Jaya Surya orcidid: 0009-0003-9871-1731 surname: Manimekalai Krishnamurthi fullname: Manimekalai Krishnamurthi, Jaya Surya organization: Department of Medicine, Madras Medical College, Chennai, India – sequence: 4 givenname: Roopshri Sunilkumar surname: Shah fullname: Shah, Roopshri Sunilkumar organization: Department of Medicine, G.M.E.R.S. Medical College, Gandhinagar, India – sequence: 5 givenname: Anjani Mahesh Kumar surname: Cherukuri fullname: Cherukuri, Anjani Mahesh Kumar organization: Department of Medicine, Guntur Medical College, Guntur, India – sequence: 6 givenname: Pranav surname: Bhatia fullname: Bhatia, Pranav organization: Seth GS Medical College and KEM Hospital, Mumbai, India – sequence: 7 givenname: Subiksha surname: Arul fullname: Arul, Subiksha organization: University of Perpetual Help System DALTA Jonelta Foundation School of Medicine, Manila, Philippines – sequence: 8 givenname: Monika orcidid: 0009-0005-2249-6945 surname: Multani fullname: Multani, Monika organization: Adesh Institute of Medical Sciences and Research, Punjab, India – sequence: 9 givenname: Adishwar surname: Singh fullname: Singh, Adishwar organization: Government Medical College and Hospital, Chandigarh, India – sequence: 10 givenname: Jenisha surname: Suyambu fullname: Suyambu, Jenisha organization: University of Perpetual Help System DALTA Jonelta Foundation School of Medicine, Manila, Philippines – sequence: 11 givenname: Kainat orcidid: 0009-0000-7995-025X surname: Asif fullname: Asif, Kainat organization: Department of Medicine, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Karachi, Pakistan – sequence: 12 givenname: Mohammed surname: Al-Tawil fullname: Al-Tawil, Mohammed organization: Faculty of Medicine, Al-Quds University Jerusalem, Palestine |
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Keywords | Transcatheter aortic valve implantation Aortic stenosis Aortic valve replacement Percutaneous Surgical cutdown Transcatheter aortic valve replacement |
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Snippet | Transcatheter aortic valve implantation (TAVI) has emerged as a potential alternative for aortic valve surgery to treat aortic valve stenosis. There is limited... |
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SubjectTerms | Aortic stenosis Aortic Valve - surgery Aortic valve replacement Aortic Valve Stenosis - surgery Femoral Artery - surgery Humans Percutaneous Postoperative Complications - epidemiology Propensity Score Surgical cutdown Transcatheter aortic valve implantation Transcatheter aortic valve replacement Transcatheter Aortic Valve Replacement - methods |
Title | Percutaneous Versus Surgical Cutdown Access for Transfemoral Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis Focusing on Propensity-Score Matched Studies |
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