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Dose approach matter? A meta-analysis of outcomes following transfemoral versus transapical transcatheter aortic valve replacement

BACKGROUND: Transcatheter aortic valve replacement (TAVR) has gained increasing acceptance for patients with aortic disease. Both transfemoral (TF-TAVR) and transapical (TA-TAVR) approach were widely adopted while their performances are limited to a few studies with controversial results. This meta-...

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Autores principales: Guo, Ruikang, Xie, Minghui, Yim, Wai Yen, Wu, Wenconghui, Jiang, Weiwei, Wang, Yin, Hu, Xingjian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8320184/
https://www.ncbi.nlm.nih.gov/pubmed/34320946
http://dx.doi.org/10.1186/s12872-021-02158-4
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author Guo, Ruikang
Xie, Minghui
Yim, Wai Yen
Wu, Wenconghui
Jiang, Weiwei
Wang, Yin
Hu, Xingjian
author_facet Guo, Ruikang
Xie, Minghui
Yim, Wai Yen
Wu, Wenconghui
Jiang, Weiwei
Wang, Yin
Hu, Xingjian
author_sort Guo, Ruikang
collection PubMed
description BACKGROUND: Transcatheter aortic valve replacement (TAVR) has gained increasing acceptance for patients with aortic disease. Both transfemoral (TF-TAVR) and transapical (TA-TAVR) approach were widely adopted while their performances are limited to a few studies with controversial results. This meta-analysis aimed to compare the mortality and morbidity of complications between TF- versus TA-TAVR based on the latest data. METHODS: Electronic databases were searched until April 2021. RCTs and observational studies comparing the outcomes between TF-TAVR versus TA-TAVR patients were included. Heterogeneity assumption was assessed by an I(2) test. The pooled odds ratios(OR) or mean differences with corresponding 95% confidence intervals (CI) were used to evaluate the difference for each end point using a fixed-effect model or random-effect model based on I(2) test. RESULTS: The meta-analysis included 1 RCT and 20 observational studies, enrolling 19,520 patients (TF-TAVR, n = 11,986 and TA-TAVR, n = 7,534). Compared with TA-TAVR, TF-TAVR patients showed significantly lower rate of postoperative in-hospital death (OR = 0.67, 95% CI 0.59–0.77, P < 0.001) and 1-year death (OR = 0.53, 95% CI 0.41–0.69, P < 0.001). Incidence of major bleeding and acute kidney injury were lower and length of hospital stay was shorter, whereas those of permanent pacemaker and major vascular complication were higher in TF-TAVR patients. There were no significant differences between TF-TAVR versus TA-TAVR for stroke and mid-term mortality. CONCLUSIONS: There were fewer early deaths in patients with transfemoral approach, whereas the number of mid-term deaths and stroke was not significantly different between two approaches. TF-TAVR was associated with lower risk of bleeding, acute kidney injury as well as shorter in-hospital stay, but higher incidence of vascular complication and permanent pacemaker implantation. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-021-02158-4.
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spelling pubmed-83201842021-07-30 Dose approach matter? A meta-analysis of outcomes following transfemoral versus transapical transcatheter aortic valve replacement Guo, Ruikang Xie, Minghui Yim, Wai Yen Wu, Wenconghui Jiang, Weiwei Wang, Yin Hu, Xingjian BMC Cardiovasc Disord Review BACKGROUND: Transcatheter aortic valve replacement (TAVR) has gained increasing acceptance for patients with aortic disease. Both transfemoral (TF-TAVR) and transapical (TA-TAVR) approach were widely adopted while their performances are limited to a few studies with controversial results. This meta-analysis aimed to compare the mortality and morbidity of complications between TF- versus TA-TAVR based on the latest data. METHODS: Electronic databases were searched until April 2021. RCTs and observational studies comparing the outcomes between TF-TAVR versus TA-TAVR patients were included. Heterogeneity assumption was assessed by an I(2) test. The pooled odds ratios(OR) or mean differences with corresponding 95% confidence intervals (CI) were used to evaluate the difference for each end point using a fixed-effect model or random-effect model based on I(2) test. RESULTS: The meta-analysis included 1 RCT and 20 observational studies, enrolling 19,520 patients (TF-TAVR, n = 11,986 and TA-TAVR, n = 7,534). Compared with TA-TAVR, TF-TAVR patients showed significantly lower rate of postoperative in-hospital death (OR = 0.67, 95% CI 0.59–0.77, P < 0.001) and 1-year death (OR = 0.53, 95% CI 0.41–0.69, P < 0.001). Incidence of major bleeding and acute kidney injury were lower and length of hospital stay was shorter, whereas those of permanent pacemaker and major vascular complication were higher in TF-TAVR patients. There were no significant differences between TF-TAVR versus TA-TAVR for stroke and mid-term mortality. CONCLUSIONS: There were fewer early deaths in patients with transfemoral approach, whereas the number of mid-term deaths and stroke was not significantly different between two approaches. TF-TAVR was associated with lower risk of bleeding, acute kidney injury as well as shorter in-hospital stay, but higher incidence of vascular complication and permanent pacemaker implantation. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-021-02158-4. BioMed Central 2021-07-28 /pmc/articles/PMC8320184/ /pubmed/34320946 http://dx.doi.org/10.1186/s12872-021-02158-4 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Review
Guo, Ruikang
Xie, Minghui
Yim, Wai Yen
Wu, Wenconghui
Jiang, Weiwei
Wang, Yin
Hu, Xingjian
Dose approach matter? A meta-analysis of outcomes following transfemoral versus transapical transcatheter aortic valve replacement
title Dose approach matter? A meta-analysis of outcomes following transfemoral versus transapical transcatheter aortic valve replacement
title_full Dose approach matter? A meta-analysis of outcomes following transfemoral versus transapical transcatheter aortic valve replacement
title_fullStr Dose approach matter? A meta-analysis of outcomes following transfemoral versus transapical transcatheter aortic valve replacement
title_full_unstemmed Dose approach matter? A meta-analysis of outcomes following transfemoral versus transapical transcatheter aortic valve replacement
title_short Dose approach matter? A meta-analysis of outcomes following transfemoral versus transapical transcatheter aortic valve replacement
title_sort dose approach matter? a meta-analysis of outcomes following transfemoral versus transapical transcatheter aortic valve replacement
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8320184/
https://www.ncbi.nlm.nih.gov/pubmed/34320946
http://dx.doi.org/10.1186/s12872-021-02158-4
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