经腔镜主动脉瓣植入术：荟萃分析和系统综述。

IF 3.2 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

International journal of cardiology Pub Date : 2024-11-12 DOI:10.1016/j.ijcard.2024.132720

Bishoy Abraham , Mina Sous , Sara Kaldas , Michael Nakhla , John Sweeney , Kwan Lee , Santiago Garcia , Marwan Saad , Sachin S. Goel , F. David Fortuin

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引用次数: 0

摘要

背景：解剖因素可能会阻碍经导管主动脉瓣植入术（TAVI）的经股动脉（TF）入路。经腔动脉（TCav）入路已被用作这些患者的替代入路。我们的目的是研究经腔静脉入路对接受 TAVI 患者的治疗效果：我们进行了一项系统性回顾和荟萃分析，包括 1996 年至 2023 年 11 月期间所有已发表的研究，这些研究对接受 TAVI 患者的 TCav 入路进行了研究。主要结果包括全因死亡率、主要血管并发症、大出血、中风和心肌梗死（MI）。随访30天和1年后报告结果：我们纳入了 8 项观察性研究，共有 517 名患者（平均年龄为 78.1±8 岁，56.6% 为女性，平均 STS 评分为 7 ± 4.5）。平均（标清）手术时间为 35 ± 9.8 分钟，平均（标清）造影剂用量为 136.3 ± 77.4 毫升。94.3%的患者手术成功。随访30天时，6.4%的患者出现全因死亡，12.2%的患者出现大出血，23.3%的患者出现输血，19%的患者出现腹膜后出血，7.9%的患者出现主要血管并发症，2.8%的患者出现心肌梗死，6.4%的患者出现AKI。1年后，全因死亡率为14.7%。在一项亚组分析（包括 3 项研究，比较了经腔静脉入路（n = 316）和其他入路（包括经颈动脉、经腋窝和经心尖）（n = 303）），30 天内全因死亡率、大出血、主要血管并发症、输血或中风方面没有差异：结论：对于髂股骨解剖结构受限的 TAVI 患者，经腔途径是可行的，且不优于其他途径。

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Transcaval access for transcatheter aortic valve implantation: A meta-analysis and systematic review

Background

Anatomical factors may preclude transfemoral (TF) arterial access for transcatheter aortic valve implantation (TAVI). Transcaval (TCav) access has been utilized as an alternative access for these patients. We aimed to investigate the outcomes of TCav access in patients undergoing TAVI.

Methods

We performed a systematic review and meta-analysis including all published studies from 1996 to November 2023 that examined TCav access in patients undergoing TAVI. The main outcomes included all cause mortality, major vascular complications, major bleeding, stroke, and myocardial infarction (MI). Outcomes were reported at 30-day and 1-year follow-up.

Results

We included 8 observational studies with a total of 517 patients (mean age 78.1±8 years, 56.6 % women, mean STS score 7 ± 4.5). Mean (SD) procedure time was 35 ± 9.8 mins and mean (SD) contrast volume was 136.3 ± 77.4 ml. Procedure success was achieved in 94.3 % of the patients. At 30-day follow-up, all-cause mortality occurred in 6.4 %, major bleeding in 12.2 %, blood transfusion in 23.3 %, retroperitoneal bleeding in 19 %, major vascular complications in 7.9 %, MI in 2.8 %, and AKI in 6.4 % of patients. At 1-year, all-cause mortality was 14.7 %. In a sub-group analysis including 3 studies comparing TCav (n = 316) to alternative accesses (including transcarotid, transaxillary, and transapical) (n = 303), there were no differences in all-cause mortality, major bleeding, major vascular complications, blood transfusion, or stroke at 30-day.

Conclusion

Transcaval approach is feasible and non-inferior to other alternative accesses in TAVI patients with prohibitive iliofemoral anatomy.

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来源期刊

International journal of cardiology 医学-心血管系统

CiteScore

6.80

自引率

5.70%

发文量

758

审稿时长

44 days

期刊介绍： The International Journal of Cardiology is devoted to cardiology in the broadest sense. Both basic research and clinical papers can be submitted. The journal serves the interest of both practicing clinicians and researchers. In addition to original papers, we are launching a range of new manuscript types, including Consensus and Position Papers, Systematic Reviews, Meta-analyses, and Short communications. Case reports are no longer acceptable. Controversial techniques, issues on health policy and social medicine are discussed and serve as useful tools for encouraging debate.