Cargando…

Large-bore arterial access closure after transcatheter aortic valve replacement: a systematic review and network meta-analysis

AIMS: As the indications to transcatheter aortic valve replacement (TAVR) expand to patients at increasingly lower risk, procedure-related vascular and bleeding complications events must be minimized. We aimed to evaluate the impact of different large-bore arterial access closure devices on clinical...

Descripción completa

Detalles Bibliográficos
Autores principales: Montalto, Claudio, Munafò, Andrea Raffaele, Arzuffi, Luca, Soriano, Francesco, Mangieri, Antonio, Nava, Stefano, De Maria, Giovanni Luigi, Burzotta, Francesco, D’Ascenzo, Fabrizio, Colombo, Antonio, Latib, Azeem, Oreglia, Jacopo Andrea, Banning, Adrian P, Porto, Italo, Crimi, Gabriele
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9472788/
https://www.ncbi.nlm.nih.gov/pubmed/36117948
http://dx.doi.org/10.1093/ehjopen/oeac043
_version_ 1784789368344412160
author Montalto, Claudio
Munafò, Andrea Raffaele
Arzuffi, Luca
Soriano, Francesco
Mangieri, Antonio
Nava, Stefano
De Maria, Giovanni Luigi
Burzotta, Francesco
D’Ascenzo, Fabrizio
Colombo, Antonio
Latib, Azeem
Oreglia, Jacopo Andrea
Banning, Adrian P
Porto, Italo
Crimi, Gabriele
author_facet Montalto, Claudio
Munafò, Andrea Raffaele
Arzuffi, Luca
Soriano, Francesco
Mangieri, Antonio
Nava, Stefano
De Maria, Giovanni Luigi
Burzotta, Francesco
D’Ascenzo, Fabrizio
Colombo, Antonio
Latib, Azeem
Oreglia, Jacopo Andrea
Banning, Adrian P
Porto, Italo
Crimi, Gabriele
author_sort Montalto, Claudio
collection PubMed
description AIMS: As the indications to transcatheter aortic valve replacement (TAVR) expand to patients at increasingly lower risk, procedure-related vascular and bleeding complications events must be minimized. We aimed to evaluate the impact of different large-bore arterial access closure devices on clinical outcomes after TAVR. METHODS AND RESULTS: We searched for papers that reported outcomes according to the type of vascular closure device/technique used after TAVR and performed a Bayesian network meta-analysis (NMA). Fifteen studies involving 9259 patients who underwent access site closure using PROSTAR™ XL percutaneous vascular surgical system (Abbott Vascular, Santa Clara, CA, USA), Perclose ProGlide™ suture-mediated closure system (Abbott), or MANTA(TM) vascular closure device (Teleflex, Morrisville, NC, USA) were included. NMA showed MANTA to have the highest likelihood of reducing a primary composite endpoint of intra-hospital death, major vascular complications, and major or life-threatening bleedings [surface under the cumulative ranking curve analysis (SUCRA) 94.8%], but this was mitigated when only randomized clinical trials and propensity-matched cohorts were included (SUCRA 56.1%). The ProGlide showed the highest likelihood to reduce major or life-threatening bleedings, especially with increasing procedural complexity, and the MANTA device to reduce major and minor vascular complications. The ProStar XL device performed poorly in all explored endpoints. CONCLUSION: Available evidence summarized through a NMA shows that ProGlide and MANTA devices appear to be both valid vascular closure devices globally and to be the best options to minimize vascular complications and reduce bleeding in patients undergoing TAVR, respectively.
format Online
Article
Text
id pubmed-9472788
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-94727882022-09-15 Large-bore arterial access closure after transcatheter aortic valve replacement: a systematic review and network meta-analysis Montalto, Claudio Munafò, Andrea Raffaele Arzuffi, Luca Soriano, Francesco Mangieri, Antonio Nava, Stefano De Maria, Giovanni Luigi Burzotta, Francesco D’Ascenzo, Fabrizio Colombo, Antonio Latib, Azeem Oreglia, Jacopo Andrea Banning, Adrian P Porto, Italo Crimi, Gabriele Eur Heart J Open Original Article AIMS: As the indications to transcatheter aortic valve replacement (TAVR) expand to patients at increasingly lower risk, procedure-related vascular and bleeding complications events must be minimized. We aimed to evaluate the impact of different large-bore arterial access closure devices on clinical outcomes after TAVR. METHODS AND RESULTS: We searched for papers that reported outcomes according to the type of vascular closure device/technique used after TAVR and performed a Bayesian network meta-analysis (NMA). Fifteen studies involving 9259 patients who underwent access site closure using PROSTAR™ XL percutaneous vascular surgical system (Abbott Vascular, Santa Clara, CA, USA), Perclose ProGlide™ suture-mediated closure system (Abbott), or MANTA(TM) vascular closure device (Teleflex, Morrisville, NC, USA) were included. NMA showed MANTA to have the highest likelihood of reducing a primary composite endpoint of intra-hospital death, major vascular complications, and major or life-threatening bleedings [surface under the cumulative ranking curve analysis (SUCRA) 94.8%], but this was mitigated when only randomized clinical trials and propensity-matched cohorts were included (SUCRA 56.1%). The ProGlide showed the highest likelihood to reduce major or life-threatening bleedings, especially with increasing procedural complexity, and the MANTA device to reduce major and minor vascular complications. The ProStar XL device performed poorly in all explored endpoints. CONCLUSION: Available evidence summarized through a NMA shows that ProGlide and MANTA devices appear to be both valid vascular closure devices globally and to be the best options to minimize vascular complications and reduce bleeding in patients undergoing TAVR, respectively. Oxford University Press 2022-08-18 /pmc/articles/PMC9472788/ /pubmed/36117948 http://dx.doi.org/10.1093/ehjopen/oeac043 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Article
Montalto, Claudio
Munafò, Andrea Raffaele
Arzuffi, Luca
Soriano, Francesco
Mangieri, Antonio
Nava, Stefano
De Maria, Giovanni Luigi
Burzotta, Francesco
D’Ascenzo, Fabrizio
Colombo, Antonio
Latib, Azeem
Oreglia, Jacopo Andrea
Banning, Adrian P
Porto, Italo
Crimi, Gabriele
Large-bore arterial access closure after transcatheter aortic valve replacement: a systematic review and network meta-analysis
title Large-bore arterial access closure after transcatheter aortic valve replacement: a systematic review and network meta-analysis
title_full Large-bore arterial access closure after transcatheter aortic valve replacement: a systematic review and network meta-analysis
title_fullStr Large-bore arterial access closure after transcatheter aortic valve replacement: a systematic review and network meta-analysis
title_full_unstemmed Large-bore arterial access closure after transcatheter aortic valve replacement: a systematic review and network meta-analysis
title_short Large-bore arterial access closure after transcatheter aortic valve replacement: a systematic review and network meta-analysis
title_sort large-bore arterial access closure after transcatheter aortic valve replacement: a systematic review and network meta-analysis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9472788/
https://www.ncbi.nlm.nih.gov/pubmed/36117948
http://dx.doi.org/10.1093/ehjopen/oeac043
work_keys_str_mv AT montaltoclaudio largeborearterialaccessclosureaftertranscatheteraorticvalvereplacementasystematicreviewandnetworkmetaanalysis
AT munafoandrearaffaele largeborearterialaccessclosureaftertranscatheteraorticvalvereplacementasystematicreviewandnetworkmetaanalysis
AT arzuffiluca largeborearterialaccessclosureaftertranscatheteraorticvalvereplacementasystematicreviewandnetworkmetaanalysis
AT sorianofrancesco largeborearterialaccessclosureaftertranscatheteraorticvalvereplacementasystematicreviewandnetworkmetaanalysis
AT mangieriantonio largeborearterialaccessclosureaftertranscatheteraorticvalvereplacementasystematicreviewandnetworkmetaanalysis
AT navastefano largeborearterialaccessclosureaftertranscatheteraorticvalvereplacementasystematicreviewandnetworkmetaanalysis
AT demariagiovanniluigi largeborearterialaccessclosureaftertranscatheteraorticvalvereplacementasystematicreviewandnetworkmetaanalysis
AT burzottafrancesco largeborearterialaccessclosureaftertranscatheteraorticvalvereplacementasystematicreviewandnetworkmetaanalysis
AT dascenzofabrizio largeborearterialaccessclosureaftertranscatheteraorticvalvereplacementasystematicreviewandnetworkmetaanalysis
AT colomboantonio largeborearterialaccessclosureaftertranscatheteraorticvalvereplacementasystematicreviewandnetworkmetaanalysis
AT latibazeem largeborearterialaccessclosureaftertranscatheteraorticvalvereplacementasystematicreviewandnetworkmetaanalysis
AT oregliajacopoandrea largeborearterialaccessclosureaftertranscatheteraorticvalvereplacementasystematicreviewandnetworkmetaanalysis
AT banningadrianp largeborearterialaccessclosureaftertranscatheteraorticvalvereplacementasystematicreviewandnetworkmetaanalysis
AT portoitalo largeborearterialaccessclosureaftertranscatheteraorticvalvereplacementasystematicreviewandnetworkmetaanalysis
AT crimigabriele largeborearterialaccessclosureaftertranscatheteraorticvalvereplacementasystematicreviewandnetworkmetaanalysis