Skip to main content

Research Repository

Advanced Search

Transcatheter Aortic Valve Implantation With and Without Resheathing and Repositioning: A Systematic Review and Meta-analysis

Moroni, Francesco; Azzalini, Lorenzo; Sondergaard, Lars; Attizzani, Guilherme F.; Garcia, Santiago; Jneid, Hani; Mamas, Mamas; Bagur, Rodrigo

Transcatheter Aortic Valve Implantation With and Without Resheathing and Repositioning: A Systematic Review and Meta-analysis Thumbnail


Authors

Francesco Moroni

Lorenzo Azzalini

Lars Sondergaard

Guilherme F. Attizzani

Santiago Garcia

Hani Jneid

Rodrigo Bagur



Abstract

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.

Citation

Moroni, F., Azzalini, L., Sondergaard, L., Attizzani, G. F., Garcia, S., Jneid, H., …Bagur, R. (2022). Transcatheter Aortic Valve Implantation With and Without Resheathing and Repositioning: A Systematic Review and Meta-analysis. Journal of the American Heart Association, 11(12), e024707 - ?. https://doi.org/10.1161/JAHA.121.024707

Journal Article Type Article
Acceptance Date Apr 13, 2022
Online Publication Date Jun 14, 2022
Publication Date Jun 21, 2022
Publicly Available Date May 30, 2023
Journal Journal of the American Heart Association
Publisher Wiley Open Access
Volume 11
Issue 12
Article Number ARTN e024707
Pages e024707 - ?
DOI https://doi.org/10.1161/JAHA.121.024707
Keywords resheathing; TAVI; aortic stenosis; TAVR; repositioning; transcatheter; self-expanding
Publisher URL https://www.ahajournals.org/doi/10.1161/JAHA.121.024707

Files






You might also like



Downloadable Citations