PDF(Pubmed)
Abstract：
Femoral access is the gold standard for transcatheter aortic valve replacement (TAVR). Safe alternative access, that represents about 15 % of TAVR cases, remains important for patients without adequate transfemoral access. We aimed to perform a systematic review and meta-analysis of studies comparing transfemoral (TF) access versus transsubclavian or transaxillary (TSc/TAx) access in patients undergoing TAVR. We searched PubMed, Cochrane CENTRAL Register, EMBASE, Web of Science, Google Scholar and ClinicalTrials.gov (inception through May 24, 2022) for studies comparing (TF) to (TSc/TAx) access for TAVR. A total of 21 studies with 75,995 unique patients who underwent TAVR (73,203 transfemoral and 2,792 TSc/TAx) were included in the analysis. There was no difference in the risk of in-hospital and 30-day all-cause mortality between the two groups (RR 0.64, 95 % CI 0.36-1.13, P = 0.12) and (RR 0.95, 95 % CI 0.64-1.41, P = 0.81), while 1-year mortality was significantly lower in the TF TAVR group (RR 0.79, 95 % CI 0.67-0.93, P = 0.005). No significant differences in major bleeding (RR 0.82, 95 % CI 0.65-1.03, P = 0.09), major vascular complications (RR 1.14, 95 % CI 0.75-1.72, P = 0.53), and stroke (RR 0.66, 95 % CI 0.42-1.02, P = 0.06) were observed. In patients undergoing TAVR, TF access is associated with significantly lower 1-year mortality compared to TSc/TAx access without differences in major bleeding, major vascular complications and stroke. While TF is the preferred approach for TAVR, TSc/TAx is a safe alternative approach. Future studies should confirm these findings, preferably in a randomized setting.
摘要：
股骨通路是经导管主动脉瓣置换术(TAVR)的金标准。安全的替代通道，这代表了大约15%的TAVR病例，对于没有足够经股动脉入路的患者仍然很重要。我们旨在对接受TAVR的患者的经股动脉（TF）入路与经锁骨下或经腋窝（TSc/TAx）入路的比较研究进行系统评价和荟萃分析。我们搜索了PubMed,Cochrane中央寄存器,EMBASE,WebofScience,GoogleScholar和ClinicalTrials.gov（成立至2022年5月24日），用于比较（TF）和（TSc/TAx）访问TAVR的研究。总共21项研究包括75,995例接受TAVR的独特患者（73,203例经股动脉和2,792例TSc/TAx）。两组的住院和30天全因死亡率风险无差异(RR0.64,95%CI0.36-1.13,P=0.12)和(RR0.95,95%CI0.64-1.41,P=0.81),而TFTAVR组的1年死亡率显著较低(RR0.79,95%CI0.67-0.93,P=0.005).大出血无显著差异(RR0.82,95%CI0.65-1.03,P=0.09),主要血管并发症(RR1.14,95%CI0.75-1.72,P=0.53),观察到卒中（RR0.66，95％CI0.42-1.02，P=0.06）。在接受TAVR的患者中，与TSc/TAx通路相比，TF通路与1年死亡率显着降低相关，在大出血方面没有差异，主要血管并发症和中风。虽然TF是TAVR的首选方法，TSc/TAx是一种安全的替代方法。未来的研究应该证实这些发现，最好是在随机设置。
