Resheathing feature during TAVI may not increase risk of periprocedural adverse events: JAHA
USA: Recent data in the Journal of the American Heart Association supports the safety of current self‐expanding transcatheter heart valves with resheathing features.
The study found that resheathing of transcatheter heart valves during transcatheter aortic valve implantation (TAVI) is associated with similar periprocedural risk versus no resheathing in several patient‐important outcomes.
There is an increasing concern that resheathing/repositioning of transcatheter heart valves during TAVI may result in an increased risk of periprocedural complications. Rodrigo Bagur, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada, and colleagues aimed to evaluate the short‐ and long‐term impact on clinical outcomes of resheathing for repositioning of transcatheter heart valves during TAVI procedures.
For this purpose, the researchers conducted a systematic search of the online databases to identify studies comparing outcomes between patients requiring resheathing/repositioning during TAVI and those who did not. The association of resheathing compared with no resheathing with clinical outcomes after TAVI was estimated using random‐effects meta‐analyses.
The meta-analysis included seven studies including 4501 participants (pooled mean age, 80.9±7.4 years; 54% women; and 1374 [30.5%] patients requiring resheathing/repositioning).
The findings of the study were as follows:
- No significant differences between the 2 groups were identified with regards to safety: 30‐day mortality (n=3125; odds ratio [OR], 0.74), stroke (n=4121; OR, 1.09), coronary obstruction (n=3000; OR, 2.35), major vascular complications (n=3125; OR, 0.92), major bleeding (n=3125; OR, 1.13), acute kidney injury (n=3495; OR, 1.30), and efficacy outcomes: device success (n=1196; OR, 0.77), need for a second valve (n=3170; OR, 2.86), significant (moderate or higher) paravalvular leak (n=1151; OR, 1.53), and permanent pacemaker implantation (n=1908; OR, 1.04).
- One‐year mortality was similar between groups (n=1972; OR, 1.00 [95% CI, 0.68–1.47]; I2=0%).
The authors conclude, "our findings imply that the use of the resheathing feature during transcatheter aortic valve implantation is not associated with an increased risk of periprocedural adverse events."
"While the study provides reassurance, there is a need for further studies to assess the role of multiple resheathing, and alternative technical strategies are to be explored when resheathing appears to be ineffective in obtaining an optimal result," they wrote in their study.
Reference:
Moroni F, Azzalini L, Sondergaard L, Attizzani GF, García S, Jneid H, Mamas MA, Bagur R. Transcatheter Aortic Valve Implantation With and Without Resheathing and Repositioning: A Systematic Review and Meta-analysis. J Am Heart Assoc. 2022 Jun 14:e024707. doi: 10.1161/JAHA.121.024707. Epub ahead of print. PMID: 35699176.
