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Kotronias, RA, Bray, JJH, Rajasundaram, S, Vincent, F, Delhaye, C, Scarsini, R, Marin, F, Terentes-Printzios, D, Halcox, JPJ, Mamas, MA, Kharbanda, R, Van Belle, E and Banning, AP (2021) Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis. Circ Cardiovasc Interv, 14 (10). pp. 1053-1061.
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Abstract
BACKGROUND: Access site vascular and bleeding complications remain problematic for patients undergoing transcatheter aortic valve replacement (TAVR). Ultrasound-guided transfemoral access approach has been suggested as a technique to reduce access site complications, but there is wide variation in adoption in TAVR. We performed a systematic review and meta-analysis to compare access site vascular and bleeding complications according to the Valve Academic Research Consortium-2 classification following the use of either ultrasound- or conventional fluoroscopy-guided transfemoral TAVR access. METHODS: Medline, Embase, Web of Science, and The Cochrane Library were searched to November 2020 for studies comparing ultrasound- and fluoroscopy-guided access for transfemoral TAVR. A priori defined primary outcomes were extracted: (1) major, (2) minor, and (3) major and minor (total) access site vascular complications and (4) life-threatening/major, (5) minor, and (6) life-threatening, major, and minor (total) access site bleeding complications. RESULTS: Eight observational studies (n=3875) were included, with a mean participant age of 82.8 years, STS score 5.81, and peripheral vascular disease in 23.5%. An ultrasound-guided approach was significantly associated with a reduced risk of total (Mantel-Haenszel odds ratio [MH-OR], 0.50 [95% CI, 0.35-0.73]), major (MH-OR, 0.51 [95% CI, 0.35-0.74]), and minor (MH-OR, 0.59 [95% CI, 0.38-0.91]) access site vascular complications. Ultrasound guidance was also significantly associated with total access site bleeding complications (MH-OR, 0.59 [95% CI, 0.39-0.90]). The association remained significant in sensitivity analyses of maximally adjusted minor and total vascular access site complications (MH-OR, 0.51 [95% CI, 0.29-0.90]; MH-OR, 0.44 [95% CI, 0.20-0.99], respectively). CONCLUSIONS: In the absence of randomized studies, our data suggests a potential benefit for ultrasound guidance to obtain percutaneous femoral access in TAVR. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42020218259.
Item Type: | Article |
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Additional Information: | . This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made. |
Uncontrolled Keywords: | fluoroscopy ◼ morbidity ◼ peripheral vascular diseases ◼ punctures ◼ transcatheter aortic valve replacement ◼ ultrasound |
Subjects: | R Medicine > R Medicine (General) |
Divisions: | Faculty of Medicine and Health Sciences > School of Medicine |
Related URLs: | |
Depositing User: | Symplectic |
Date Deposited: | 06 Oct 2021 11:12 |
Last Modified: | 10 Feb 2022 15:46 |
URI: | https://eprints.keele.ac.uk/id/eprint/10098 |