Meta-analysis of minimalist versus standard care approach for transcatheter aortic valve replacement

ABSTRACT

Background

The change in practice of transcatheter aortic valve replacement (TAVR) to a minimalist approach is a debate.

Methods

Online database search for studies that compared the minimalist approach with the standard approach for TAVR were searched from inception through September 2020. We calculated pooled odds ratios (ORs) and 95% confidence intervals (CIs) using the fixed or random-effects model.

Results

A total of 9 studies with 2,880 TAVR patients (minimalist TAVR;1066 and standard TAVR; 1,814) were included. Compared to standard approach, there were no significant differences in in-hospital mortality, 30-day mortality, or hospital readmissions. However, there was a reduced risk of acute kidney injury (OR0.49;95%CI0.27–0.89), major bleeding (OR0.21;95%CI0.12–0.38) and major vascular complications (OR0.60,95%CI0.39–0.91) associated with the minimalist TAVR group. There was comparatively shorter hospital length of stay (mean difference −2.41;95%CI-2.99,-1.83) days, procedural time (mean difference −43.99;95%CI-67.25,-20.75) minutes, fluoroscopy time (mean difference −2.69;95%CI-3.44,-1.94) minutes and contrast volume (mean difference −26.98;95%CI-42.18,-11.79) ml in the minimalist TAVR group.

Conclusions

This meta-analysis demonstrated potential benefits of the minimalist TAVR approach over the standard approach regarding some adverse clinical outcomes as well as procedural outcomes without significant differences in mortality or readmission rates.

KEYWORDS:

• Transcatheter aortic valve replacement
• minimalist TAVR
• major vascular complications
• major bleeding
• mortality
• complications

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers in this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here

Additional information

Funding

This paper was not funded.