Moroni, F, Azzalini, L, Sondergaard, L, Attizzani, GF, García, S, Jneid, H, Mamas, MA and Bagur, R (2022) Transcatheter Aortic Valve Implantation With and Without Resheathing and Repositioning: A Systematic Review and Meta-analysis. Journal of the American Heart Association, 11 (12). e024707 - ?. ISSN 2047-9980

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Background There is a concern that resheathing/repositioning of transcatheter heart valves during transcatheter aortic valve implantation (TAVI) may lead to an increased risk of periprocedural complications. We aimed to evaluate the short- and long-term impact on clinical outcomes of resheathing for repositioning of transcatheter heart valves during TAVI procedures. Methods and Results We conducted a systematic search of Embase, MEDLINE, and Cochrane Central Register of Controlled Trials databases to identify studies comparing outcomes between patients requiring resheathing/repositioning during TAVI and those who did not. Random-effects meta-analyses were used to estimate the association of resheathing compared with no resheathing with clinical outcomes after TAVI. Seven studies including 4501 participants (pooled mean age, 80.9±7.4 years; 54% women; and 1374 [30.5%] patients requiring resheathing/repositioning) were included in this study. No significant differences between the 2 groups were identified with regards to safety: 30-day mortality (n=3125; odds ratio [OR], 0.74 [95% confidence interval [CI], 0.41-1.33]; I2=0%), stroke (n=4121; OR, 1.09 [95% CI, 0.74-1.62]; I2=0%), coronary obstruction (n=3000; OR, 2.35 [95% CI, 0.17-33.47]; I2=75%), major vascular complications (n=3125; OR, 0.92 [95% CI, 0.66-1.33]; I2=0%), major bleeding (n=3125; OR, 1.13 [95% CI, 0.94-2.01]; I2=39%), acute kidney injury (n=3495; OR, 1.30 [95% CI, 0.64-2.62]; I2=44%), and efficacy outcomes: device success (n=1196; OR, 0.77 [95% CI, 0.51-1.14]; I2=0%), need for a second valve (n=3170; OR, 2.86 [95% CI, 0.96-8.48]; I2=62%), significant (moderate or higher) paravalvular leak (n=1151; OR, 1.53 [95% CI, 0.83-2.80]; I2=0%), and permanent pacemaker implantation (n=1908; OR, 1.04 [95% CI, 0.68-1.57]; I2=58%). One-year mortality was similar between groups (n=1972; OR, 1.00 [95% CI, 0.68-1.47]; I2=0%). Conclusions Resheathing of transcatheter heart valves during TAVI is associated with similar periprocedural risk compared with no resheathing in several patient-important outcomes. These data support the safety of current self-expanding transcatheter heart valves with resheathing features. Registration URL:; Unique identifier: CRD42021273715.

Item Type: Article
Additional Information: Copyright © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
Uncontrolled Keywords: resheathing; TAVI; aortic stenosis; TAVR; repositioning; transcatheter; self-expanding
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > School of Medicine
Related URLs:
Depositing User: Symplectic
Date Deposited: 09 Aug 2022 08:51
Last Modified: 09 Aug 2022 08:51

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