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Transcarotid versus trans-axillary/subclavian transcatheter aortic valve replacement (TAVR): A systematic review and meta-analysis.
Dawadi, Sagun; Oli, Prakash Raj; Shrestha, Dhan Bahadur; Shtembari, Jurgen; Pant, Kailash; Shrestha, Bishesh; Mattumpuram, Jishanth; Katz, Daniel H.
Afiliación
  • Dawadi S; Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, 44600, Nepal.
  • Oli PR; Department of Internal Medicine, Province Hospital, Birendranagar, Surkhet, Karnali Province 21700, Nepal.
  • Shrestha DB; Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60608, USA.
  • Shtembari J; Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60608, USA.
  • Pant K; Department of Internal Medicine, Division of Cardiovascular Medicine, University of Illinois College of Medicine, OSF Healthcare, Peoria, IL 61614, USA.
  • Shrestha B; Division of Cardiology, Department of Internal Medicine, Bassett Medical Center, 1 Atwell Rd, Cooperstown, NY 13326, USA.
  • Mattumpuram J; Division of Cardiology, Department of Internal Medicine, University of Louisville School of Medicine, 550 S Jackson St, Louisville, KY 40202, USA. Electronic address: jishanth.mattumpuram@louisville.edu.
  • Katz DH; Division of Cardiology, Department of Internal Medicine, Bassett Medical Center, 1 Atwell Rd, Cooperstown, NY 13326, USA.
Curr Probl Cardiol ; 49(5): 102488, 2024 May.
Article en En | MEDLINE | ID: mdl-38417474
ABSTRACT

BACKGROUND:

Transcatheter Aortic Valve Replacement (TAVR) is the treatment of choice in patients with severe aortic stenosis. Transcarotid (TCa) or Trans-axillary/subclavian (TAx/Sc) are safer and less invasive non-femoral approaches, where transfemoral access is difficult or impossible to obtain.

METHODS:

This meta-analysis was performed based on PRISMA guidelines after registering in PROSPERO (CRD42023482842). This meta-analysis was performed to compare the safety of the transcarotid and trans-axillary/subclavian approach for TAVR including studies from inception to October 2023.

RESULTS:

Seven studies with a total of 6227 patients were included in the analysis (TCa 2566; TAx/Sc 3661). Transcarotid TAVR approach had a favorable trend for composite of stroke and all-cause mortality (OR 0.79, CI 0.60-1.04), all-cause mortality, stroke, major vascular complication, and new requirement of permanent pacemaker though those were statistically insignificant. On sub-analysis of the results of the studies based on the territory (USA vs French), composite outcome of all cause mortality, stroke and major bleeding (OR 0.54, CI 0.54-0.81), composite of stroke and all cause mortality (OR 0.64, CI 0.50-0.81), and stroke/TIA (OR 0.53, CI 0.39-0.73) showed lower odds of occurrence among patient managed with TCa approach in the American cohort.

CONCLUSION:

Overall, transcarotid approach had favorable though statistically insignificant odds for composite (stroke and all-cause mortality) and individual outcomes (stroke, all-cause mortality, etc.). There are significant variations in observed outcomes based on study's geographic location. Large prospective randomized clinical trials comparing the two approaches with representative samples are necessary to guide the clinicians in choosing among these approaches.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Estenosis de la Válvula Aórtica / Arteria Subclavia / Arteria Axilar / Reemplazo de la Válvula Aórtica Transcatéter Límite: Humans Idioma: En Revista: Curr Probl Cardiol Año: 2024 Tipo del documento: Article País de afiliación: Nepal Pais de publicación: Países Bajos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Estenosis de la Válvula Aórtica / Arteria Subclavia / Arteria Axilar / Reemplazo de la Válvula Aórtica Transcatéter Límite: Humans Idioma: En Revista: Curr Probl Cardiol Año: 2024 Tipo del documento: Article País de afiliación: Nepal Pais de publicación: Países Bajos