Transcatheter Aortic Valve Implantation With and Without Resheathing and Repositioning: A Systematic Review and Meta‐analysis
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...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.024707 |
| _version_ | 1797301675247009792 |
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| author | Francesco Moroni Lorenzo Azzalini Lars Sondergaard Guilherme F. Attizzani Santiago García Hani Jneid Mamas A. Mamas Rodrigo Bagur |
| author_facet | Francesco Moroni Lorenzo Azzalini Lars Sondergaard Guilherme F. Attizzani Santiago García Hani Jneid Mamas A. Mamas Rodrigo Bagur |
| author_sort | Francesco Moroni |
| collection | DOAJ |
| description | 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: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021273715. |
| first_indexed | 2024-03-07T23:25:58Z |
| format | Article |
| id | doaj.art-ac29c407ea8b46d0a25526a7616a051b |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-07T23:25:58Z |
| publishDate | 2022-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-ac29c407ea8b46d0a25526a7616a051b2024-02-21T04:31:45ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-06-01111210.1161/JAHA.121.024707Transcatheter Aortic Valve Implantation With and Without Resheathing and Repositioning: A Systematic Review and Meta‐analysisFrancesco Moroni0Lorenzo Azzalini1Lars Sondergaard2Guilherme F. Attizzani3Santiago García4Hani Jneid5Mamas A. Mamas6Rodrigo Bagur7Division of Cardiology Pauley Heart CenterVirginia Commonwealth University Richmond VADivision of Cardiology Department of Medicine University of Washington Seattle WAThe Heart Centre, RigshospitaletCopenhagen University Hospital Copenhagen DenmarkHarrington Heart and Vascular InstituteUniversity Hospitals Cleveland Medical Center Cleveland OHThe Carl and Edyth Lindner Center for Research and Education, The Christ Hospital Cincinnati OHDivision of Cardiology Baylor School of Medicine and the Michael E. DeBakey VAMC Houston TXKeele Cardiovascular Research Group Centre for Prognosis ResearchInstitute of Primary Care and Health SciencesKeele University Stoke‐on‐Trent United KingdomKeele Cardiovascular Research Group Centre for Prognosis ResearchInstitute of Primary Care and Health SciencesKeele University Stoke‐on‐Trent United KingdomBackground 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: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021273715.https://www.ahajournals.org/doi/10.1161/JAHA.121.024707aortic stenosisrepositioningresheathingself‐expandingTAVITAVR |
| spellingShingle | Francesco Moroni Lorenzo Azzalini Lars Sondergaard Guilherme F. Attizzani Santiago García Hani Jneid Mamas A. Mamas Rodrigo Bagur Transcatheter Aortic Valve Implantation With and Without Resheathing and Repositioning: A Systematic Review and Meta‐analysis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic stenosis repositioning resheathing self‐expanding TAVI TAVR |
| title | Transcatheter Aortic Valve Implantation With and Without Resheathing and Repositioning: A Systematic Review and Meta‐analysis |
| title_full | Transcatheter Aortic Valve Implantation With and Without Resheathing and Repositioning: A Systematic Review and Meta‐analysis |
| title_fullStr | Transcatheter Aortic Valve Implantation With and Without Resheathing and Repositioning: A Systematic Review and Meta‐analysis |
| title_full_unstemmed | Transcatheter Aortic Valve Implantation With and Without Resheathing and Repositioning: A Systematic Review and Meta‐analysis |
| title_short | Transcatheter Aortic Valve Implantation With and Without Resheathing and Repositioning: A Systematic Review and Meta‐analysis |
| title_sort | transcatheter aortic valve implantation with and without resheathing and repositioning a systematic review and meta analysis |
| topic | aortic stenosis repositioning resheathing self‐expanding TAVI TAVR |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.024707 |
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