Meta-analysis Evaluating the Safety and Efficacy of Transcarotid Transcatheter Aortic Valve Implantation

• Published in: The American journal of cardiology 2019-12, Vol.124 (12), p.1940-1946
• Main Authors: Usman, Muhammad Shariq, Rawasia, Wasiq Faraz, Siddiqi, Tariq Jamal, Mujeeb, Firzah Abdul, Nadeem, Shahrukh, Alkhouli, Mohamad
• Format: Article
• Language: English
• Subjects: Age; Aortic valve; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Bleeding; Cardiac Catheterization - methods; Carotid Arteries; Cerebral infarction; Complications; Confidence intervals; Consortia; Female; Heart attacks; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - mortality; Humans; Implantation; Ischemia; Kidneys; Male; Males; Meta-analysis; Mortality; Myocardial infarction; Patient Safety - statistics & numerical data; Patients; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Risk Assessment; Stroke; Studies; Survival Rate; Systematic review; Transient ischemic attack; Transplants & implants; Treatment Outcome; Vascular Access Devices
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2019.09.015

We performed a systemic review and meta-analysis of studies evaluating transcarotid vascular access for transcatheter aortic valve implantation (TAVI). Published studies evaluating transcarotid vascular access for TAVI were included in this analysis. Outcomes of interest included 30-day mortality, stroke/transient ischemic attack (TIA), new pacemaker implantation, acute kidney injury (AKI), major vascular complication, major bleeding, and myocardial infarction. Pooled estimate for 30-day mortality was 5.3% (95% confidence interval [CI] 4.0% to 6.8%; I2 = 4%), stroke/TIA was 3.4% (95% CI 2.4% to 4.6%; I2 = 0%), new pacemaker implantation was 15.3% (95% CI 10.8% to 19.7%; I2 = 72%), AKI was 3.4% (95% CI 1.3% to 6.5%; I2 = 58%), major vascular complication was 2.4% (95% CI 1.1% to 3.7%; I2 = 46%), major bleeding was 4.3% (95% CI 2.8% to 6.1%; I2 = 11%), and myocardial infarction was 1.1% (95% CI 0.4% to 2.0%; I2 = 0%). Metaregression was carried out to study the association of effect size with the continuous study-level covariates that included average age, proportion of males, and mean STS score. In this regard, mean STS score showed association with major vascular complications (coefficient: 0.008; p = 0.049). Cumulative meta-analysis carried out showed that there was temporal trend of decreasing incidence of stroke/TIA, major vascular complications, and AKI for transcarotid TAVI. In conclusion, transcarotid access for TAVI is a reasonable choice in patients requiring alternate access to transfemoral route.