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Carotid access for transcatheter aortic valve replacement: A meta‐analysis
Author(s) -
Sharma Sharan Prakash,
Chaudhary Rahul,
Ghuneim Angela,
Harder William,
David Shukri,
Choksi Nishit,
Kondur Snigdha,
Kambhatla Swathi,
Kambhatla Sujata,
Kondur Ashok
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.29244
Subject(s) - medicine , tamponade , stroke (engine) , valve replacement , cardiology , cardiac tamponade , surgery , complication , stenosis , mechanical engineering , engineering
Abstract Objective We sought to evaluate the feasibility and safety of carotid access transcatheter aortic valve replacement (TAVR) by performing a meta‐analysis of published cases. Background Several case series and regional data have provided initial basis for carotid access TAVR in patients with prohibitive femoral approach. We performed this meta‐analysis to provide further evidence of feasibility and safety of carotid TAVR. Methods We searched PubMed, EMBASE, CINAHL, and Cochrane CENTRAL for any study on carotid access TAVR involving ⩾5 patients since inception till March 1, 2020. Random‐effects model was used to compute overall effects. The outcomes analyzed were all‐cause mortality, Transient ischemic attack (TIA)/stroke, need for permanent pacemaker (PPM) implantation, pericardial tamponade, access site complications, major bleeding, and length of stay. Results There was a total of 17 retrospective studies ( n = 2082) with a median follow‐up of 1 month. Mean age of the patient was 80 years. Mean Euroscore and STS scores were 15 ± 6.2 and 7.9 ± 3.3, respectively. The procedural success rate was 99%. The rate of all‐cause mortality was 6.7% (range 4.6–9.7%, p < .001, I 2 = 67%). Incidence of TIA/stroke was 3.9% (range 3.1–4.8%, p < .001, I 2 = 0%) and PPM implantation was 16.7% (range 12.5–21.9%, p < .001, I 2 = 56%). Rate of pericardial tamponade, vascular complication, and major bleeding were 1.7, 2.5, and 7%, respectively. Average length of hospital stay was 7.7 days. Conclusion Our results show that transcarotid approach is a feasible option in patients with prohibitive femoral access for TAVR.