期刊论文详细信息
PeerJ
Direct aortic route versus transaxillary route for transcatheter aortic valve replacement: a systematic review and meta-analysis
article
Hsiu-An Lee1  I-Li Su1  Shao-Wei Chen1  Victor Chien-Chia Wu2  Dong-Yi Chen2  Pao-Hsien Chu2  An-Hsun Chou3  Yu-Ting Cheng1  Pyng-Jing Lin1  Feng-Chun Tsai1 
[1] Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University;Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University;Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
关键词: Transcatheter aortic valve replacement;    Transaxillary;    Direct aortic;    Trans-subclavian;    Transaortic;    TAVR;    TAVI;   
DOI  :  10.7717/peerj.9102
学科分类:社会科学、人文和艺术(综合)
来源: Inra
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【 摘 要 】

Background The transfemoral route is contraindicated in nearly 10% of transcatheter aortic valve replacement (TAVR) candidates because of unsuitable iliofemoral vessels. Transaxillary (TAx) and direct aortic (DAo) routes are the principal nonfemoral TAVR routes; however, few studies have compared their outcomes. Methods We performed a systematic review and meta-analysis to compare the rates of mortality, stroke, and other adverse events of TAx and DAo TAVR. The study was prospectively registered with PROSPERO (registration number: CRD42017069788). We searched Medline, PubMed, Embase, and Cochrane databases for studies reporting the outcomes of DAo or TAx TAVR in at least 10 patients. Studies that did not use the Valve Academic Research Consortium definitions were excluded. We included studies that did not directly compare the two approaches and then pooled rates of events from the included studies for comparison. Results In total, 31 studies were included in the quantitative meta-analysis, with 2,883 and 2,172 patients in the DAo and TAx TAVR groups, respectively. Compared with TAx TAVR, DAo TAVR had a lower Society of Thoracic Surgery (STS) score, shorter fluoroscopic time, and less contrast volume use. The 30-day mortality rates were significantly higher in the DAo TAVR group (9.6%, 95% confidence interval (CI) = [8.4–10.9]) than in the TAx TAVR group (5.7%, 95% CI = [4.8–6.8]; P for heterogeneity <0.001). DAo TAVR was associated with a significantly lower risk of stroke in the overall study population (2.6% vs. 5.8%, P for heterogeneity <0.001) and in the subgroup of studies with a mean STS score of ≥8 (1.6% vs. 6.2%, P for heterogeneity = 0.005). DAo TAVR was also associated with lower risks of permanent pacemaker implantation (12.3% vs. 20.1%, P for heterogeneity = 0.009) and valve malposition (2.0% vs. 10.2%, P for heterogeneity = 0.023) than was TAx TAVR. Conclusions DAo TAVR increased 30-day mortality rate compared with TAx TAVR; by contrast, TAx TAVR increased postoperative stroke, permanent pacemaker implantation, and valve malposition risks compared with DAo TAVR.

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