Waqas T Qureshi1, Amartya Kundu1, Tanveer Mir2, Amna Khan1, Saif Anwaruddin3, Yasar Sattar4, Adedotun Ogunsua1, Abhishek Dutta5, Chaudry Nasir Majeed6, Jennifer Walker7, Nikolaos Kakouros1. 1. Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA. 2. Department of Internal Medicine, Detroit Medical Centre, Wayne State University, Detroit USA. 3. Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. 4. Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst Hospital, Queens, NY, USA. 5. Department of Critical Care Medicine, Memorial Sloan Kettering, NY, USA. 6. Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA. 7. Division of Cardiothoracic Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
Abstract
BACKGROUND: The change in practice of transcatheter aortic valve replacement (TAVR) to a minimalist approach is a debate. METHODS: Online database search for studies that compared the minimalist approach with the standard approach for TAVR were searched from inception through September 2020. We calculated pooled odds ratios (ORs) and 95% confidence intervals (CIs) using the fixed or random-effects model. RESULTS: A total of 9 studies with 2,880 TAVR patients (minimalist TAVR;1066 and standard TAVR; 1,814) were included. Compared to standard approach, there were no significant differences in in-hospital mortality, 30-day mortality, or hospital readmissions. However, there was a reduced risk of acute kidney injury (OR0.49;95%CI0.27-0.89), major bleeding (OR0.21;95%CI0.12-0.38) and major vascular complications (OR0.60,95%CI0.39-0.91) associated with the minimalist TAVR group. There was comparatively shorter hospital length of stay (mean difference -2.41;95%CI-2.99,-1.83) days, procedural time (mean difference -43.99;95%CI-67.25,-20.75) minutes, fluoroscopy time (mean difference -2.69;95%CI-3.44,-1.94) minutes and contrast volume (mean difference -26.98;95%CI-42.18,-11.79) ml in the minimalist TAVR group. CONCLUSIONS: This meta-analysis demonstrated potential benefits of the minimalist TAVR approach over the standard approach regarding some adverse clinical outcomes as well as procedural outcomes without significant differences in mortality or readmission rates.
BACKGROUND: The change in practice of transcatheter aortic valve replacement (TAVR) to a minimalist approach is a debate. METHODS: Online database search for studies that compared the minimalist approach with the standard approach for TAVR were searched from inception through September 2020. We calculated pooled odds ratios (ORs) and 95% confidence intervals (CIs) using the fixed or random-effects model. RESULTS: A total of 9 studies with 2,880 TAVR patients (minimalist TAVR;1066 and standard TAVR; 1,814) were included. Compared to standard approach, there were no significant differences in in-hospital mortality, 30-day mortality, or hospital readmissions. However, there was a reduced risk of acute kidney injury (OR0.49;95%CI0.27-0.89), major bleeding (OR0.21;95%CI0.12-0.38) and major vascular complications (OR0.60,95%CI0.39-0.91) associated with the minimalist TAVR group. There was comparatively shorter hospital length of stay (mean difference -2.41;95%CI-2.99,-1.83) days, procedural time (mean difference -43.99;95%CI-67.25,-20.75) minutes, fluoroscopy time (mean difference -2.69;95%CI-3.44,-1.94) minutes and contrast volume (mean difference -26.98;95%CI-42.18,-11.79) ml in the minimalist TAVR group. CONCLUSIONS: This meta-analysis demonstrated potential benefits of the minimalist TAVR approach over the standard approach regarding some adverse clinical outcomes as well as procedural outcomes without significant differences in mortality or readmission rates.
Entities:
Keywords:
Transcatheter aortic valve replacement; complications; major bleeding; major vascular complications; minimalist TAVR; mortality