Comparison of early and midterm outcomes after transsubclavian/axillary versus transfemoral, transapical, or transaortic transcatheter aortic valve implantation

Hisato Takagi; Yosuke Hari; Kouki Nakashima; Toshiki Kuno; Tomo Ando; ALICE (All-Literature Investigation of Cardiovascular Evidence) Group

doi:10.1016/j.hrtlng.2019.04.002

Comparison of early and midterm outcomes after transsubclavian/axillary versus transfemoral, transapical, or transaortic transcatheter aortic valve implantation

Heart Lung. 2019 Nov-Dec;48(6):519-529. doi: 10.1016/j.hrtlng.2019.04.002. Epub 2019 May 7.

Authors

Hisato Takagi¹, Yosuke Hari², Kouki Nakashima², Toshiki Kuno³, Tomo Ando⁴; ALICE (All-Literature Investigation of Cardiovascular Evidence) Group

Affiliations

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.

PMID: 31076179
DOI: 10.1016/j.hrtlng.2019.04.002

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.

Keywords: Meta-analysis; Transaortic transcatheter aortic valve implantation; Transapical transcatheter aortic valve implantation; Transfemoral transcatheter aortic valve implantation; Transsubclavian/transaxillary transcatheter aortic valve implantation.

Publication types

Comparative Study
Meta-Analysis
Review

MeSH terms

Aortic Valve / surgery*
Heart Valve Prosthesis*
Humans
Time Factors
Transcatheter Aortic Valve Replacement / methods*
Treatment Outcome