Transcatheter Aortic Valve Implantation With and Without Resheathing and Repositioning: A Systematic Review and Meta‐analysis

BACKGROUND: There is a concern that resheathing/repositioning of transcatheter heart valves during transcatheter aortic valve implantation (TAVI) may lead to an increased risk of periprocedural complications. We aimed to evaluate the short‐ and long‐term impact on clinical outcomes of resheathing for repositioning of transcatheter heart valves during TAVI procedures. METHODS AND RESULTS: We conducted a systematic search of Embase, MEDLINE, and Cochrane Central Register of Controlled Trials databases to identify studies comparing outcomes between patients requiring resheathing/repositioning during TAVI and those who did not. Random‐effects meta‐analyses were used to estimate the association of resheathing compared with no resheathing with clinical outcomes after TAVI. Seven studies including 4501 participants (pooled mean age, 80.9±7.4 years; 54% women; and 1374 [30.5%] patients requiring resheathing/repositioning) were included in this study. No significant differences between the 2 groups were identified with regards to safety: 30‐day mortality (n=3125; odds ratio [OR], 0.74 [95% confidence interval [CI], 0.41–1.33]; I (2)=0%), stroke (n=4121; OR, 1.09 [95% CI, 0.74–1.62]; I (2)=0%), coronary obstruction (n=3000; OR, 2.35 [95% CI, 0.17–33.47]; I (2)=75%), major vascular complications (n=3125; OR, 0.92 [95% CI, 0.66–1.33]; I (2)=0%), major bleeding (n=3125; OR, 1.13 [95% CI, 0.94–2.01]; I (2)=39%), acute kidney injury (n=3495; OR, 1.30 [95% CI, 0.64–2.62]; I (2)=44%), and efficacy outcomes: device success (n=1196; OR, 0.77 [95% CI, 0.51–1.14]; I (2)=0%), need for a second valve (n=3170; OR, 2.86 [95% CI, 0.96–8.48]; I (2)=62%), significant (moderate or higher) paravalvular leak (n=1151; OR, 1.53 [95% CI, 0.83–2.80]; I (2)=0%), and permanent pacemaker implantation (n=1908; OR, 1.04 [95% CI, 0.68–1.57]; I (2)=58%). One‐year mortality was similar between groups (n=1972; OR, 1.00 [95% CI, 0.68–1.47]; I (2)=0%). CONCLUSIONS: Resheathing of transcatheter heart valves during TAVI is associated with similar periprocedural risk compared with no resheathing in several patient‐important outcomes. These data support the safety of current self‐expanding transcatheter heart valves with resheathing features. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021273715.