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Comparison of cusp-overlap projection and standard three-cusp coplanar view during self-expanding transcatheter aortic valve replacement: A systematic review and meta-analysis

OBJECTIVE: Permanent pacemaker implantation (PPI) is a common complication after transcatheter aortic valve replacement (TAVR). Recently, the cusp-overlap projection (COP) technique was thought to be a feasible method to reduce PPI risk. However, the evidence is still relatively scarce. Therefore, t...

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Autores principales: Chen, Yujing, Zhu, Gangjie, Liu, Xin, Wu, Weilin, Chai, Hui, Tao, Minjie, Kong, Dongmei, Li, Yingzi, Wang, Li
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9428452/
https://www.ncbi.nlm.nih.gov/pubmed/36061562
http://dx.doi.org/10.3389/fcvm.2022.927642
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author Chen, Yujing
Zhu, Gangjie
Liu, Xin
Wu, Weilin
Chai, Hui
Tao, Minjie
Kong, Dongmei
Li, Yingzi
Wang, Li
author_facet Chen, Yujing
Zhu, Gangjie
Liu, Xin
Wu, Weilin
Chai, Hui
Tao, Minjie
Kong, Dongmei
Li, Yingzi
Wang, Li
author_sort Chen, Yujing
collection PubMed
description OBJECTIVE: Permanent pacemaker implantation (PPI) is a common complication after transcatheter aortic valve replacement (TAVR). Recently, the cusp-overlap projection (COP) technique was thought to be a feasible method to reduce PPI risk. However, the evidence is still relatively scarce. Therefore, this meta-analysis was performed to compare COP and standard three-cusp coplanar (TCC) projection technique. METHODS: PubMed and EMBASE databases were systematically searched for relevant literature published from the inception (EMBASE from 1974 and PubMed from 1966) to 16 April 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The primary outcome of interest was post-operative (including in-hospital and 30-day) PPI. RESULTS: Total of 3,647 subjects from 11 studies were included in this meta-analysis. Of those, 1,453 underwent self-expanding TAVR using COP and 2,194 using TCC technique. In a pooled analysis, the cumulative PPI incidence was 9.3% [95% confidence interval (CI): 6.9–11.7%] and 18.9% (95% CI: 15.5–22.3%) in the COP group and TCC group, respectively. The application of the COP technique was associated with a significant PPI risk reduction (I(2) = 40.3% and heterogeneity Chi-square p = 0.070, random-effects OR: 0.49, 95% CI: 0.36–0.66, p < 0.001). A higher implantation depth was achieved in the COP group compared with the TCC group [standardized mean difference (SMD) = −0.324, 95% CI: (−0.469, −0.180)]. There was no significant difference between the two groups in second valve implantation, prosthesis pop-out, fluoroscopic time, post-operative left bundle branch block, mortality, stroke, moderate/severe paravalvular leakage, mean gradient, and length of hospital stay. However, radiation doses were higher in the COP group [SMD = 0.394, 95% CI: (0.216, 0.572), p < 0.001]. CONCLUSION: In self-expanding TAVR, the application of the cusp overlap projection technique was associated with a lower risk of PPI compared with the standard TCC technique. SYSTEMATIC REVIEW REGISTRATION: [https://inplasy.com/inplasy-2022-4-0092/], identifier [INPLASY202240092].
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spelling pubmed-94284522022-09-01 Comparison of cusp-overlap projection and standard three-cusp coplanar view during self-expanding transcatheter aortic valve replacement: A systematic review and meta-analysis Chen, Yujing Zhu, Gangjie Liu, Xin Wu, Weilin Chai, Hui Tao, Minjie Kong, Dongmei Li, Yingzi Wang, Li Front Cardiovasc Med Cardiovascular Medicine OBJECTIVE: Permanent pacemaker implantation (PPI) is a common complication after transcatheter aortic valve replacement (TAVR). Recently, the cusp-overlap projection (COP) technique was thought to be a feasible method to reduce PPI risk. However, the evidence is still relatively scarce. Therefore, this meta-analysis was performed to compare COP and standard three-cusp coplanar (TCC) projection technique. METHODS: PubMed and EMBASE databases were systematically searched for relevant literature published from the inception (EMBASE from 1974 and PubMed from 1966) to 16 April 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The primary outcome of interest was post-operative (including in-hospital and 30-day) PPI. RESULTS: Total of 3,647 subjects from 11 studies were included in this meta-analysis. Of those, 1,453 underwent self-expanding TAVR using COP and 2,194 using TCC technique. In a pooled analysis, the cumulative PPI incidence was 9.3% [95% confidence interval (CI): 6.9–11.7%] and 18.9% (95% CI: 15.5–22.3%) in the COP group and TCC group, respectively. The application of the COP technique was associated with a significant PPI risk reduction (I(2) = 40.3% and heterogeneity Chi-square p = 0.070, random-effects OR: 0.49, 95% CI: 0.36–0.66, p < 0.001). A higher implantation depth was achieved in the COP group compared with the TCC group [standardized mean difference (SMD) = −0.324, 95% CI: (−0.469, −0.180)]. There was no significant difference between the two groups in second valve implantation, prosthesis pop-out, fluoroscopic time, post-operative left bundle branch block, mortality, stroke, moderate/severe paravalvular leakage, mean gradient, and length of hospital stay. However, radiation doses were higher in the COP group [SMD = 0.394, 95% CI: (0.216, 0.572), p < 0.001]. CONCLUSION: In self-expanding TAVR, the application of the cusp overlap projection technique was associated with a lower risk of PPI compared with the standard TCC technique. SYSTEMATIC REVIEW REGISTRATION: [https://inplasy.com/inplasy-2022-4-0092/], identifier [INPLASY202240092]. Frontiers Media S.A. 2022-08-17 /pmc/articles/PMC9428452/ /pubmed/36061562 http://dx.doi.org/10.3389/fcvm.2022.927642 Text en Copyright © 2022 Chen, Zhu, Liu, Wu, Chai, Tao, Kong, Li and Wang. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Chen, Yujing
Zhu, Gangjie
Liu, Xin
Wu, Weilin
Chai, Hui
Tao, Minjie
Kong, Dongmei
Li, Yingzi
Wang, Li
Comparison of cusp-overlap projection and standard three-cusp coplanar view during self-expanding transcatheter aortic valve replacement: A systematic review and meta-analysis
title Comparison of cusp-overlap projection and standard three-cusp coplanar view during self-expanding transcatheter aortic valve replacement: A systematic review and meta-analysis
title_full Comparison of cusp-overlap projection and standard three-cusp coplanar view during self-expanding transcatheter aortic valve replacement: A systematic review and meta-analysis
title_fullStr Comparison of cusp-overlap projection and standard three-cusp coplanar view during self-expanding transcatheter aortic valve replacement: A systematic review and meta-analysis
title_full_unstemmed Comparison of cusp-overlap projection and standard three-cusp coplanar view during self-expanding transcatheter aortic valve replacement: A systematic review and meta-analysis
title_short Comparison of cusp-overlap projection and standard three-cusp coplanar view during self-expanding transcatheter aortic valve replacement: A systematic review and meta-analysis
title_sort comparison of cusp-overlap projection and standard three-cusp coplanar view during self-expanding transcatheter aortic valve replacement: a systematic review and meta-analysis
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9428452/
https://www.ncbi.nlm.nih.gov/pubmed/36061562
http://dx.doi.org/10.3389/fcvm.2022.927642
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