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Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis
Circulation: Cardiovascular Interventions, Volume: 14, Issue: 10
Swansea University Authors:
Jonathan Bray, Julian Halcox
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DOI (Published version): 10.1161/circinterventions.121.010742
Abstract
Background:Access site vascular and bleeding complications remain problematic for patients undergoing transcatheter aortic valve replacement (TAVR). Ultrasound-guided transfemoral access approach has been suggested as a technique to reduce access site complications, but there is wide variation in ad...
Published in: | Circulation: Cardiovascular Interventions |
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ISSN: | 1941-7640 1941-7632 |
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Ovid Technologies (Wolters Kluwer Health)
2021
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<?xml version="1.0"?><rfc1807><datestamp>2021-11-16T12:35:42.7977687</datestamp><bib-version>v2</bib-version><id>57222</id><entry>2021-06-28</entry><title>Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis</title><swanseaauthors><author><sid>c8b2c8d8ea027cdd8b0a318ab9d89f78</sid><firstname>Jonathan</firstname><surname>Bray</surname><name>Jonathan Bray</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>3676f695eeda169d0f8c618adf27c04b</sid><ORCID>0000-0001-6926-2947</ORCID><firstname>Julian</firstname><surname>Halcox</surname><name>Julian Halcox</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2021-06-28</date><deptcode>FGMHL</deptcode><abstract>Background:Access site vascular and bleeding complications remain problematic for patients undergoing transcatheter aortic valve replacement (TAVR). Ultrasound-guided transfemoral access approach has been suggested as a technique to reduce access site complications, but there is wide variation in adoption in TAVR. We performed a systematic review and meta-analysis to compare access site vascular and bleeding complications according to the Valve Academic Research Consortium-2 classification following the use of either ultrasound- or conventional fluoroscopy-guided transfemoral TAVR access.Methods:Medline, Embase, Web of Science, and The Cochrane Library were searched to November 2020 for studies comparing ultrasound- and fluoroscopy-guided access for transfemoral TAVR. A priori defined primary outcomes were extracted: (1) major, (2) minor, and (3) major and minor (total) access site vascular complications and (4) life-threatening/major, (5) minor, and (6) life-threatening, major, and minor (total) access site bleeding complications.Results:Eight observational studies (n=3875) were included, with a mean participant age of 82.8 years, STS score 5.81, and peripheral vascular disease in 23.5%. An ultrasound-guided approach was significantly associated with a reduced risk of total (Mantel-Haenszel odds ratio [MH-OR], 0.50 [95% CI, 0.35–0.73]), major (MH-OR, 0.51 [95% CI, 0.35–0.74]), and minor (MH-OR, 0.59 [95% CI, 0.38–0.91]) access site vascular complications. Ultrasound guidance was also significantly associated with total access site bleeding complications (MH-OR, 0.59 [95% CI, 0.39–0.90]). The association remained significant in sensitivity analyses of maximally adjusted minor and total vascular access site complications (MH-OR, 0.51 [95% CI, 0.29–0.90]; MH-OR, 0.44 [95% CI, 0.20–0.99], respectively).Conclusions:In the absence of randomized studies, our data suggests a potential benefit for ultrasound guidance to obtain percutaneous femoral access in TAVR.</abstract><type>Journal Article</type><journal>Circulation: Cardiovascular Interventions</journal><volume>14</volume><journalNumber>10</journalNumber><paginationStart/><paginationEnd/><publisher>Ovid Technologies (Wolters Kluwer Health)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>1941-7640</issnPrint><issnElectronic>1941-7632</issnElectronic><keywords>fluoroscopy; morbidity; peripheral vascular diseases; punctures; transcatheter aortic valve replacement; ultrasound</keywords><publishedDay>1</publishedDay><publishedMonth>10</publishedMonth><publishedYear>2021</publishedYear><publishedDate>2021-10-01</publishedDate><doi>10.1161/circinterventions.121.010742</doi><url/><notes/><college>COLLEGE NANME</college><department>Medicine, Health and Life Science - Faculty</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>FGMHL</DepartmentCode><institution>Swansea University</institution><apcterm>Other</apcterm><lastEdited>2021-11-16T12:35:42.7977687</lastEdited><Created>2021-06-28T09:37:37.6453666</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Rafail A.</firstname><surname>Kotronias</surname><order>1</order></author><author><firstname>Jonathan</firstname><surname>Bray</surname><order>2</order></author><author><firstname>Skanda</firstname><surname>Rajasundaram</surname><order>3</order></author><author><firstname>Flavien</firstname><surname>Vincent</surname><order>4</order></author><author><firstname>Cedric</firstname><surname>Delhaye</surname><order>5</order></author><author><firstname>Roberto</firstname><surname>Scarsini</surname><order>6</order></author><author><firstname>Federico</firstname><surname>Marin</surname><order>7</order></author><author><firstname>Dimitrios</firstname><surname>Terentes-Printzios</surname><order>8</order></author><author><firstname>Julian</firstname><surname>Halcox</surname><orcid>0000-0001-6926-2947</orcid><order>9</order></author><author><firstname>Mamas A.</firstname><surname>Mamas</surname><order>10</order></author><author><firstname>Rajesh</firstname><surname>Kharbanda</surname><order>11</order></author><author><firstname>Eric Van</firstname><surname>Belle</surname><order>12</order></author><author><firstname>Adrian P.</firstname><surname>Banning</surname><order>13</order></author></authors><documents><document><filename>57222__21090__75b4462ef77c4a168e98b3b937fc4920.pdf</filename><originalFilename>57222.VOR.pdf</originalFilename><uploaded>2021-10-04T18:39:26.1384998</uploaded><type>Output</type><contentLength>1673082</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>https://creativecommons.org/licenses/by-nc-nd/4.0/</licence></document></documents><OutputDurs/></rfc1807> |
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2021-11-16T12:35:42.7977687 v2 57222 2021-06-28 Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis c8b2c8d8ea027cdd8b0a318ab9d89f78 Jonathan Bray Jonathan Bray true false 3676f695eeda169d0f8c618adf27c04b 0000-0001-6926-2947 Julian Halcox Julian Halcox true false 2021-06-28 FGMHL Background:Access site vascular and bleeding complications remain problematic for patients undergoing transcatheter aortic valve replacement (TAVR). Ultrasound-guided transfemoral access approach has been suggested as a technique to reduce access site complications, but there is wide variation in adoption in TAVR. We performed a systematic review and meta-analysis to compare access site vascular and bleeding complications according to the Valve Academic Research Consortium-2 classification following the use of either ultrasound- or conventional fluoroscopy-guided transfemoral TAVR access.Methods:Medline, Embase, Web of Science, and The Cochrane Library were searched to November 2020 for studies comparing ultrasound- and fluoroscopy-guided access for transfemoral TAVR. A priori defined primary outcomes were extracted: (1) major, (2) minor, and (3) major and minor (total) access site vascular complications and (4) life-threatening/major, (5) minor, and (6) life-threatening, major, and minor (total) access site bleeding complications.Results:Eight observational studies (n=3875) were included, with a mean participant age of 82.8 years, STS score 5.81, and peripheral vascular disease in 23.5%. An ultrasound-guided approach was significantly associated with a reduced risk of total (Mantel-Haenszel odds ratio [MH-OR], 0.50 [95% CI, 0.35–0.73]), major (MH-OR, 0.51 [95% CI, 0.35–0.74]), and minor (MH-OR, 0.59 [95% CI, 0.38–0.91]) access site vascular complications. Ultrasound guidance was also significantly associated with total access site bleeding complications (MH-OR, 0.59 [95% CI, 0.39–0.90]). The association remained significant in sensitivity analyses of maximally adjusted minor and total vascular access site complications (MH-OR, 0.51 [95% CI, 0.29–0.90]; MH-OR, 0.44 [95% CI, 0.20–0.99], respectively).Conclusions:In the absence of randomized studies, our data suggests a potential benefit for ultrasound guidance to obtain percutaneous femoral access in TAVR. Journal Article Circulation: Cardiovascular Interventions 14 10 Ovid Technologies (Wolters Kluwer Health) 1941-7640 1941-7632 fluoroscopy; morbidity; peripheral vascular diseases; punctures; transcatheter aortic valve replacement; ultrasound 1 10 2021 2021-10-01 10.1161/circinterventions.121.010742 COLLEGE NANME Medicine, Health and Life Science - Faculty COLLEGE CODE FGMHL Swansea University Other 2021-11-16T12:35:42.7977687 2021-06-28T09:37:37.6453666 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Rafail A. Kotronias 1 Jonathan Bray 2 Skanda Rajasundaram 3 Flavien Vincent 4 Cedric Delhaye 5 Roberto Scarsini 6 Federico Marin 7 Dimitrios Terentes-Printzios 8 Julian Halcox 0000-0001-6926-2947 9 Mamas A. Mamas 10 Rajesh Kharbanda 11 Eric Van Belle 12 Adrian P. Banning 13 57222__21090__75b4462ef77c4a168e98b3b937fc4920.pdf 57222.VOR.pdf 2021-10-04T18:39:26.1384998 Output 1673082 application/pdf Version of Record true This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made. true eng https://creativecommons.org/licenses/by-nc-nd/4.0/ |
title |
Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis |
spellingShingle |
Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis Jonathan Bray Julian Halcox |
title_short |
Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis |
title_full |
Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis |
title_fullStr |
Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis |
title_full_unstemmed |
Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis |
title_sort |
Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis |
author_id_str_mv |
c8b2c8d8ea027cdd8b0a318ab9d89f78 3676f695eeda169d0f8c618adf27c04b |
author_id_fullname_str_mv |
c8b2c8d8ea027cdd8b0a318ab9d89f78_***_Jonathan Bray 3676f695eeda169d0f8c618adf27c04b_***_Julian Halcox |
author |
Jonathan Bray Julian Halcox |
author2 |
Rafail A. Kotronias Jonathan Bray Skanda Rajasundaram Flavien Vincent Cedric Delhaye Roberto Scarsini Federico Marin Dimitrios Terentes-Printzios Julian Halcox Mamas A. Mamas Rajesh Kharbanda Eric Van Belle Adrian P. Banning |
format |
Journal article |
container_title |
Circulation: Cardiovascular Interventions |
container_volume |
14 |
container_issue |
10 |
publishDate |
2021 |
institution |
Swansea University |
issn |
1941-7640 1941-7632 |
doi_str_mv |
10.1161/circinterventions.121.010742 |
publisher |
Ovid Technologies (Wolters Kluwer Health) |
college_str |
Faculty of Medicine, Health and Life Sciences |
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facultyofmedicinehealthandlifesciences |
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Faculty of Medicine, Health and Life Sciences |
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facultyofmedicinehealthandlifesciences |
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Faculty of Medicine, Health and Life Sciences |
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Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine |
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description |
Background:Access site vascular and bleeding complications remain problematic for patients undergoing transcatheter aortic valve replacement (TAVR). Ultrasound-guided transfemoral access approach has been suggested as a technique to reduce access site complications, but there is wide variation in adoption in TAVR. We performed a systematic review and meta-analysis to compare access site vascular and bleeding complications according to the Valve Academic Research Consortium-2 classification following the use of either ultrasound- or conventional fluoroscopy-guided transfemoral TAVR access.Methods:Medline, Embase, Web of Science, and The Cochrane Library were searched to November 2020 for studies comparing ultrasound- and fluoroscopy-guided access for transfemoral TAVR. A priori defined primary outcomes were extracted: (1) major, (2) minor, and (3) major and minor (total) access site vascular complications and (4) life-threatening/major, (5) minor, and (6) life-threatening, major, and minor (total) access site bleeding complications.Results:Eight observational studies (n=3875) were included, with a mean participant age of 82.8 years, STS score 5.81, and peripheral vascular disease in 23.5%. An ultrasound-guided approach was significantly associated with a reduced risk of total (Mantel-Haenszel odds ratio [MH-OR], 0.50 [95% CI, 0.35–0.73]), major (MH-OR, 0.51 [95% CI, 0.35–0.74]), and minor (MH-OR, 0.59 [95% CI, 0.38–0.91]) access site vascular complications. Ultrasound guidance was also significantly associated with total access site bleeding complications (MH-OR, 0.59 [95% CI, 0.39–0.90]). The association remained significant in sensitivity analyses of maximally adjusted minor and total vascular access site complications (MH-OR, 0.51 [95% CI, 0.29–0.90]; MH-OR, 0.44 [95% CI, 0.20–0.99], respectively).Conclusions:In the absence of randomized studies, our data suggests a potential benefit for ultrasound guidance to obtain percutaneous femoral access in TAVR. |
published_date |
2021-10-01T04:12:47Z |
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1763753871678636032 |
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11.021648 |