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Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis

BACKGROUND: Access site vascular and bleeding complications remain problematic for patients undergoing transcatheter aortic valve replacement (TAVR). Ultrasound-guided transfemoral access approach has been suggested as a technique to reduce access site complications, but there is wide variation in a...

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Autores principales: Kotronias, Rafail A., Bray, Jonathan J.H., Rajasundaram, Skanda, Vincent, Flavien, Delhaye, Cedric, Scarsini, Roberto, Marin, Federico, Terentes-Printzios, Dimitrios, Halcox, Julian P.J., Mamas, Mamas A., Kharbanda, Rajesh, Van Belle, Eric, Banning, Adrian P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8522629/
https://www.ncbi.nlm.nih.gov/pubmed/34538068
http://dx.doi.org/10.1161/CIRCINTERVENTIONS.121.010742
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author Kotronias, Rafail A.
Bray, Jonathan J.H.
Rajasundaram, Skanda
Vincent, Flavien
Delhaye, Cedric
Scarsini, Roberto
Marin, Federico
Terentes-Printzios, Dimitrios
Halcox, Julian P.J.
Mamas, Mamas A.
Kharbanda, Rajesh
Van Belle, Eric
Banning, Adrian P.
author_facet Kotronias, Rafail A.
Bray, Jonathan J.H.
Rajasundaram, Skanda
Vincent, Flavien
Delhaye, Cedric
Scarsini, Roberto
Marin, Federico
Terentes-Printzios, Dimitrios
Halcox, Julian P.J.
Mamas, Mamas A.
Kharbanda, Rajesh
Van Belle, Eric
Banning, Adrian P.
author_sort Kotronias, Rafail A.
collection PubMed
description BACKGROUND: Access site vascular and bleeding complications remain problematic for patients undergoing transcatheter aortic valve replacement (TAVR). Ultrasound-guided transfemoral access approach has been suggested as a technique to reduce access site complications, but there is wide variation in adoption in TAVR. We performed a systematic review and meta-analysis to compare access site vascular and bleeding complications according to the Valve Academic Research Consortium-2 classification following the use of either ultrasound- or conventional fluoroscopy-guided transfemoral TAVR access. METHODS: Medline, Embase, Web of Science, and The Cochrane Library were searched to November 2020 for studies comparing ultrasound- and fluoroscopy-guided access for transfemoral TAVR. A priori defined primary outcomes were extracted: (1) major, (2) minor, and (3) major and minor (total) access site vascular complications and (4) life-threatening/major, (5) minor, and (6) life-threatening, major, and minor (total) access site bleeding complications. RESULTS: Eight observational studies (n=3875) were included, with a mean participant age of 82.8 years, STS score 5.81, and peripheral vascular disease in 23.5%. An ultrasound-guided approach was significantly associated with a reduced risk of total (Mantel-Haenszel odds ratio [MH-OR], 0.50 [95% CI, 0.35–0.73]), major (MH-OR, 0.51 [95% CI, 0.35–0.74]), and minor (MH-OR, 0.59 [95% CI, 0.38–0.91]) access site vascular complications. Ultrasound guidance was also significantly associated with total access site bleeding complications (MH-OR, 0.59 [95% CI, 0.39–0.90]). The association remained significant in sensitivity analyses of maximally adjusted minor and total vascular access site complications (MH-OR, 0.51 [95% CI, 0.29–0.90]; MH-OR, 0.44 [95% CI, 0.20–0.99], respectively). CONCLUSIONS: In the absence of randomized studies, our data suggests a potential benefit for ultrasound guidance to obtain percutaneous femoral access in TAVR. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42020218259.
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spelling pubmed-85226292021-10-20 Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis Kotronias, Rafail A. Bray, Jonathan J.H. Rajasundaram, Skanda Vincent, Flavien Delhaye, Cedric Scarsini, Roberto Marin, Federico Terentes-Printzios, Dimitrios Halcox, Julian P.J. Mamas, Mamas A. Kharbanda, Rajesh Van Belle, Eric Banning, Adrian P. Circ Cardiovasc Interv Original Articles BACKGROUND: Access site vascular and bleeding complications remain problematic for patients undergoing transcatheter aortic valve replacement (TAVR). Ultrasound-guided transfemoral access approach has been suggested as a technique to reduce access site complications, but there is wide variation in adoption in TAVR. We performed a systematic review and meta-analysis to compare access site vascular and bleeding complications according to the Valve Academic Research Consortium-2 classification following the use of either ultrasound- or conventional fluoroscopy-guided transfemoral TAVR access. METHODS: Medline, Embase, Web of Science, and The Cochrane Library were searched to November 2020 for studies comparing ultrasound- and fluoroscopy-guided access for transfemoral TAVR. A priori defined primary outcomes were extracted: (1) major, (2) minor, and (3) major and minor (total) access site vascular complications and (4) life-threatening/major, (5) minor, and (6) life-threatening, major, and minor (total) access site bleeding complications. RESULTS: Eight observational studies (n=3875) were included, with a mean participant age of 82.8 years, STS score 5.81, and peripheral vascular disease in 23.5%. An ultrasound-guided approach was significantly associated with a reduced risk of total (Mantel-Haenszel odds ratio [MH-OR], 0.50 [95% CI, 0.35–0.73]), major (MH-OR, 0.51 [95% CI, 0.35–0.74]), and minor (MH-OR, 0.59 [95% CI, 0.38–0.91]) access site vascular complications. Ultrasound guidance was also significantly associated with total access site bleeding complications (MH-OR, 0.59 [95% CI, 0.39–0.90]). The association remained significant in sensitivity analyses of maximally adjusted minor and total vascular access site complications (MH-OR, 0.51 [95% CI, 0.29–0.90]; MH-OR, 0.44 [95% CI, 0.20–0.99], respectively). CONCLUSIONS: In the absence of randomized studies, our data suggests a potential benefit for ultrasound guidance to obtain percutaneous femoral access in TAVR. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42020218259. Lippincott Williams & Wilkins 2021-09-20 /pmc/articles/PMC8522629/ /pubmed/34538068 http://dx.doi.org/10.1161/CIRCINTERVENTIONS.121.010742 Text en © 2021 The Authors. https://creativecommons.org/licenses/by-nc-nd/4.0/Circulation: Cardiovascular Interventions is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.
spellingShingle Original Articles
Kotronias, Rafail A.
Bray, Jonathan J.H.
Rajasundaram, Skanda
Vincent, Flavien
Delhaye, Cedric
Scarsini, Roberto
Marin, Federico
Terentes-Printzios, Dimitrios
Halcox, Julian P.J.
Mamas, Mamas A.
Kharbanda, Rajesh
Van Belle, Eric
Banning, Adrian P.
Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis
title Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis
title_full Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis
title_fullStr Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis
title_full_unstemmed Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis
title_short Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis
title_sort ultrasound- versus fluoroscopy-guided strategy for transfemoral transcatheter aortic valve replacement access: a systematic review and meta-analysis
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8522629/
https://www.ncbi.nlm.nih.gov/pubmed/34538068
http://dx.doi.org/10.1161/CIRCINTERVENTIONS.121.010742
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