The American journal of cardiology
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Review Meta Analysis
Meta-Analysis of Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Valve Stenosis.
Transcatheter aortic valve replacement (TAVR) is a viable option in the treatment of severe aortic stenosis in patients at high risk for surgery. We sought to further investigate outcomes in patients at low to intermediate risk with aortic stenosis who underwent surgical aortic valve replacement (SAVR) versus TAVR. We systematically searched the electronic databases, MEDLINE, PubMed, EMBASE, and Cochrane for prospective cohort studies of the effects of TAVR versus SAVR on clinical outcomes (30-day mortality, all-cause mortality, stroke and myocardial infarction, major vascular complications, paravalvular regurgitation, permanent pacemaker implantation, major bleeding, and acute kidney injury). ⋯ TAVR was associated with higher rates of vascular complications, permanent pacemaker implantation, and moderate or severe paravalvular regurgitation (p <0.001 for all), whereas more major bleeding events were seen in the SAVR group (p <0.001). In conclusion, TAVR was found to have similar survival and stroke rates and lower major bleeding rates as compared with SAVR in patients at low or intermediate surgical risk. However, SAVR was associated with less pacemaker placements and paravalvular regurgitation rates.
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Review Meta Analysis
Meta-Analysis of Radial Versus Femoral Access for Percutaneous Coronary Interventions in Non-ST-Segment Elevation Acute Coronary Syndrome.
Radial access for percutaneous coronary intervention (PCI) has been shown to reduce mortality and vascular complications compared to femoral access in patients with ST-segment elevation myocardial infarction. However, efficacy and safety of radial access PCI in non-ST-segment elevation acute coronary syndrome (NSTE ACS) is not well understood. A systematic search of electronic databases was performed through July 2015 to search and identify relevant studies. ⋯ Radial access was associated with significant reduction in major bleeding (OR 0.52, 95% CI 0.36 to 0.73, p = 0.0002), access-site bleeding (OR 0.41, 95% CI 0.22 to 0.78, p = 0.007), and need for blood transfusions (OR 0.61, 95% CI 0.41 to 0.91, p = 0.02). Furthermore, the 1-year mortality was significantly lower in radial approach (OR 0.72, 95% CI 0.55 to 0.95, p = 0.02). In conclusion, in patients with non-ST-segment elevation acute coronary syndrome undergoing PCI, radial access is associated with decreased bleeding and access-site complications.