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Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis

Rafail A. Kotronias, Jonathan Bray, Skanda Rajasundaram, Flavien Vincent, Cedric Delhaye, Roberto Scarsini, Federico Marin, Dimitrios Terentes-Printzios, Julian Halcox Orcid Logo, Mamas A. Mamas, Rajesh Kharbanda, Eric Van Belle, Adrian P. Banning

Circulation: Cardiovascular Interventions, Volume: 14, Issue: 10

Swansea University Authors: Jonathan Bray, Julian Halcox Orcid Logo

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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...

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Published in: Circulation: Cardiovascular Interventions
ISSN: 1941-7640 1941-7632
Published: Ovid Technologies (Wolters Kluwer Health) 2021
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URI: https://cronfa.swan.ac.uk/Record/cronfa57222
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fullrecord <?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>MEDS</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&#x2013;0.73]), major (MH-OR, 0.51 [95% CI, 0.35&#x2013;0.74]), and minor (MH-OR, 0.59 [95% CI, 0.38&#x2013;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&#x2013;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&#x2013;0.90]; MH-OR, 0.44 [95% CI, 0.20&#x2013;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>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</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>
spelling 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 MEDS 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 Medical School COLLEGE CODE MEDS 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
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
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 2021-10-01T20:02:58Z
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