A meta-analysis and meta-regression of long-term outcomes of transcatheter versus surgical aortic valve replacement for severe aortic stenosis

Villablanca, Pedro A.; Mathew, Verghese; Thourani, Vinod H.; Rodés‐Cabau, Josep; Bangalore, Sripal; Makkiya, Mohammed; Vlismas, Peter; Briceño, David; Slovut, David P.; Taub, Cynthia C.; McCarthy, Patrick M.; Augoustides, John; Ramakrishna, Harish

doi:10.1016/j.ijcard.2016.10.003

Cited by 52 publications

(51 citation statements)

References 81 publications

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“…The reported prevalence of AKI after TAVR ranges from 5% to as high as 57% . AKI following TAVR is independently associated with a 5‐ to 8‐fold increase in 30‐day mortality and a > 3‐fold increase in 1‐year mortality . Although few studies have looked at AKI following SAVR specifically, 30‐day mortality for patients with AKI following other cardiac surgery (most commonly coronary artery bypass grafting) has ranged from 6% to 45%, compared with 1% to 3% for patients without AKI .…”

Section: Importance and Definitionmentioning

confidence: 99%

“…Preoperative or patient‐related factors associated with AKI are the presence of CKD (elevated baseline Cr or reduced GFR), hypertension, higher Society of Thoracic Surgeons (STS) or EuroSCORE risk score, diabetes mellitus, and the presence of peripheral arterial disease or chronic obstructive pulmonary disease (Figure ) . A review of the literature shows an inverse correlation between baseline GFR and risk of AKI . Further, a recent substudy from the PARTNER 1 registry showed that in patients with baseline renal impairment, those with worsening GFR had an increased all‐cause mortality at 1 year.…”

Section: Pathogenesis and Risk Factorsmentioning

confidence: 99%

“…It is also known that in high‐volume centers with increased operator experience, the incidence of AKI is lower. Given that the most commonly employed approach is transfemoral, operator experience is certainly higher with this approach, and thus this further confounds the picture …”

Section: Pathogenesis and Risk Factorsmentioning

confidence: 99%

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Acute kidney injury post–transcatheter aortic valve replacement

Ram

Mezue

Pressman

et al. 2017

Clinical Cardiology

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Transcatheter aortic valve replacement (TAVR) is a treatment option in high-risk patients with severe aortic stenosis who are not surgical candidates. In light of emerging evidence, it is being increasingly performed even in intermediate-risk patients in recent years. Patients who develop acute kidney injury (AKI) following TAVR are known to have worse outcomes. The objective of this concise review was to identify the prevalence and the impact of AKI following TAVR on patient outcomes by including the most recent literature in our search. After a thorough search on MEDLINE, Google Scholar, and PubMed, we included all literature relevant to AKI following TAVR. We found that AKI was caused by a variety of reasons, such as hemodynamic instability during rapid pacing, blood transfusion, periprocedural embolization, and use of contrast medium, to name a few. In patients who developed AKI following TAVR, 30-day and 1-year mortality were increased. Further, in these patients, length and cost of hospital stay were increased as well. Preventive measures such as optimal periprocedural hydration, careful contrast use, and techniques to prevent embolization during device implantation have been tried with limited success. Given that TAVR is expected to be increasingly performed, this review aimed to summarize the rapidly expanding currently available literature in an effort to reduce procedural complications and thereby improve patient outcomes.

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Section: Importance and Definitionmentioning

confidence: 99%

Section: Pathogenesis and Risk Factorsmentioning

confidence: 99%

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Acute kidney injury post–transcatheter aortic valve replacement

Ram

Mezue

Pressman

et al. 2017

Clinical Cardiology

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“…In contemporary practice, more TAVR cases are performed under local anesthesia and under transthoracic echocardiography guidance. Villablanca et al reported that local anesthesia shortened length of hospital stay by approximately 2 days . Also, their analysis suggested lower 30‐days mortality in when local anesthesia is used compared to general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…These factors are especially important in patients such as post‐SAVR, who require very close monitoring during their intensive care unit stay. Conversely, with advances in TAVR technology and operator expertise, the complication rates have significantly decreased with the need for close monitoring not as intense as compared with their post‐SAVR counterparts as shown in cumulative meta‐analysis . Therefore, in non‐teaching hospitals, where close monitoring and sub‐specialties may not be readily available compared with teaching hospitals, TAVR patients could have better outcomes compared to post‐SAVR patients do.…”

Section: Discussionmentioning

confidence: 99%

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement in non‐teaching hospitals

Ando

Adegbala

Villablanca

et al. 2018

Cathet Cardio Intervent

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Objectives To assess the in‐hospital outcomes of transcatheter aortic valve replacement (TAVR) vs. surgical aortic valve replacement (SAVR) in non‐teaching hospitals. Background TAVR has become widely available in the United States. However, the comparative outcomes of TAVR vs. SAVR in non‐teaching hospitals are largely under explored. Methods We queried the Nationwide Inpatient Sample database from 2011 to September 2015 to identify those who were 50 years or above and underwent either trans‐arterial TAVR or SAVR at non‐teaching hospital. In‐hospital clinical outcomes were compared with odds ratio (OR) in propensity‐matched cohorts. Results We identified un‐weighted 957 and 7,465 SAVR admissions. In propensity‐matched model, 596 admissions in each arm were included for final analysis. In‐patient mortality (3.9 vs. 2.5%, OR 1.54, P = 0.34), acute kidney injury requiring dialysis (2.2 vs. 2.7%, OR 0.80, P = 0.57), stroke (2.0 vs. 3.2%, OR 0.61, P = 0.20), and pacemaker placement (8.9 vs. 6.4%, OR 1.47, P = 0.09) was similar between TAVR and SAVR. Sub‐group analysis showed that female and those with prior coronary artery bypass surgery had higher risk of in‐patient morality in TAVR admission. Cost was higher (59,103 vs. 53,411 dollars, P = 0.006) but length of stay was shorter in TAVR (6.9 vs. 10.2 days, P < 0.001). Conclusions TAVR conferred similar in‐hospital mortality and major peri‐procedural complications compared with SAVR in non‐teaching hospitals. For those with limited access to teaching hospitals, non‐teaching hospitals appear to be a reasonable option for candidates of aortic valve replacement for severe aortic stenosis.

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Safety and efficacy of hybrid vascular closure technique using both a suture‐ and collagen‐mediated closure device after transfemoral transcatheter aortic valve implantation

Al-Ani

Hoffmann

Lueder

et al. 2019

Cathet Cardio Intervent

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Objectives: To evaluate the clinical utility and feasibility of a hybrid technique for obtaining vascular hemostasis by combining a suture-and a collagen-mediated system after transfemoral transcatheter aortic valve implantation (TF TAVI) in a real-world setting.Methods: In 75 consecutive TF TAVI procedures, we investigated a hybrid closing method to achieve hemostasis at the large bore puncture site using a combination of one presuture closure system (ProGlide) and one collagen-mediated system (Angio-Seal). Vascular complications at puncture site were recorded until discharge. Results: Successful hemostasis by the hybrid technique was achieved in 74 out of 75 patients, and the method was well tolerated by all patients. In 73 patients, (97.3%) neither puncture site related complications nor serious early or late bleedings were observed during a median hospital stay of 2 days postprocedure.Conclusion: This single-center registry study indicates that a percutaneous hybrid closure technique is safe and efficacious in closing large bore arteriotomies. It is an easy and reliable technique that may contribute to simplifying TAVI procedures.Study registration: The data was collected from an internal quality control registry on treatment of patients with valvular heart disease with or without coronary artery disease, No 2014/17280,

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A meta-analysis and meta-regression of long-term outcomes of transcatheter versus surgical aortic valve replacement for severe aortic stenosis

Cited by 52 publications

References 81 publications

Acute kidney injury post–transcatheter aortic valve replacement

Acute kidney injury post–transcatheter aortic valve replacement

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement in non‐teaching hospitals

Safety and efficacy of hybrid vascular closure technique using both a suture‐ and collagen‐mediated closure device after transfemoral transcatheter aortic valve implantation

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