Hisato Takagi1, Yosuke Hari2, Kouki Nakashima2, Toshiki Kuno3, Tomo Ando4. 1. Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan; Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan. Electronic address: kfgth973@ybb.ne.jp. 2. Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan; Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan. 3. Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, NY, United States. 4. Department of Cardiology, Detroit Medical Center, Detroit, MI, United States.
Abstract
BACKGROUND: Outcomes after transsubclavian/transaxillary (TSc/TAx)-transcatheter aortic valve implantation (TAVI) have been unclear. OBJECTIVES: To compare outcomes after TSc/TAx-TAVI versus transfemoral (TF)-TAVI, transapical (TAp)-TAVI, or transaortic (TAo)-TAVI, we performed meta-analysis of currently available studies. METHODS: Studies considered for inclusion met the following criteria: the study population was patients undergoing TAVI; patients were assigned to TSc/TAx-TAVI and TF-TAVI, TAp-TAVI, or TAo-TAVI; and at least one of postprocedural early (30-day or in-hospital) or late (including early) outcomes was reported. An odds or hazard ratio of each early or late outcome with its 95% confidence interval for TSc/TAx-TAVI versus the other approach was extracted from each individual study and combined in the random-effects model. RESULTS: Our search identified 15 eligible reports from 12 studies including 10,528 patients. Pooled analysis of early all-cause mortality demonstrated a statistically significant reduction after TSc/TAx-TAVI compared with TAp-TAVI (P = 0.003) or TAo-TAVI (P = 0.03). Pooled analysis of early pacemaker implantation demonstrated a statistically significant increase after TSc/TAx-TAVI compared with TAp-TAVI (P = 0.0001) or TAo-TAVI (P < 0.00001). Pooled analysis of midterm all-cause mortality demonstrated a statistically significant increase after TSc/TAx-TAVI compared with TF-TAVI (P = 0.007). CONCLUSIONS: Early all-cause mortality was lower after TSc/TAx-TAVI than TAp-TAVI or TAo-TAVI, early pacemaker implantation was more frequent after TSc/TAx-TAVI than TAp-TAVI or TAo-TAVI, and midterm all-cause mortality was higher after TSc/TAx-TAVI than TF-TAVI.
BACKGROUND: Outcomes after transsubclavian/transaxillary (TSc/TAx)-transcatheter aortic valve implantation (TAVI) have been unclear. OBJECTIVES: To compare outcomes after TSc/TAx-TAVI versus transfemoral (TF)-TAVI, transapical (TAp)-TAVI, or transaortic (TAo)-TAVI, we performed meta-analysis of currently available studies. METHODS: Studies considered for inclusion met the following criteria: the study population was patients undergoing TAVI; patients were assigned to TSc/TAx-TAVI and TF-TAVI, TAp-TAVI, or TAo-TAVI; and at least one of postprocedural early (30-day or in-hospital) or late (including early) outcomes was reported. An odds or hazard ratio of each early or late outcome with its 95% confidence interval for TSc/TAx-TAVI versus the other approach was extracted from each individual study and combined in the random-effects model. RESULTS: Our search identified 15 eligible reports from 12 studies including 10,528 patients. Pooled analysis of early all-cause mortality demonstrated a statistically significant reduction after TSc/TAx-TAVI compared with TAp-TAVI (P = 0.003) or TAo-TAVI (P = 0.03). Pooled analysis of early pacemaker implantation demonstrated a statistically significant increase after TSc/TAx-TAVI compared with TAp-TAVI (P = 0.0001) or TAo-TAVI (P < 0.00001). Pooled analysis of midterm all-cause mortality demonstrated a statistically significant increase after TSc/TAx-TAVI compared with TF-TAVI (P = 0.007). CONCLUSIONS: Early all-cause mortality was lower after TSc/TAx-TAVI than TAp-TAVI or TAo-TAVI, early pacemaker implantation was more frequent after TSc/TAx-TAVI than TAp-TAVI or TAo-TAVI, and midterm all-cause mortality was higher after TSc/TAx-TAVI than TF-TAVI.
Authors: Lukas Stastny; Christoph Krapf; Julia Dumfarth; Simone Gasser; Axel Bauer; Guy Friedrich; Bernhard Metzler; Gudrun Feuchtner; Agnes Mayr; Michael Grimm; Nikolaos Bonaros Journal: Front Cardiovasc Med Date: 2022-03-04