Wee Ian Jun Yan, Stonier Thomas, Harrison Michael, Choong Andrew M T L
SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Princess Alexandra Hospital, Harlow, London, United Kingdom.
J Cardiol. 2018 Jun;71(6):525-533. doi: 10.1016/j.jjcc.2018.01.010. Epub 2018 Mar 2.
The carotid artery is a novel access route for transcatheter aortic valve implantation (TAVI), especially useful in patients unsuitable for traditional access routes including transfemoral (TF), subclavian, transapical (TAp), and aortic (TAo). This systematic review summarizes the evidence on TAVI via the carotid artery for its efficacy and safety.
A systematic review was conducted as per the Preferred Reporting Instructions for Systematic Reviews and Meta-analysis (PRISMA) guidelines on three online databases: Medline (via Pubmed), SCOPUS, and Cochrane Database.
There were 8 non-randomized controlled trials identified comprising 650 patients in four TAVI vascular access sites: transcarotid (TC) (N=364), TF (N=100), TAp (N=151), TAo (N=35). The 30-day rates of mortality and neurological complications for TC TAVI were 6.5% and 3.8%, respectively, with 1 incidence of myocardial infarction. Other complications included vascular complications (7.7%), insertion of new pacemaker (17.4%), atrial fibrillation (5.2%), and acute kidney injury (6.9%), bleeding episodes (14.3%), of which 13 (3.6%) cases were life-threatening; 5 (1.4%) were major; and 35 (9.3%) were minor cases. Follow-up to 1 year showed 19 further deaths. There were no significant differences in terms of mortality rates [risk ratio (RR)=0.31, 95%CI 0.05-1.79; p=0.19] and onset of dialysis treatment (RR=2.53, 95%CI 0.31-19.78; p=0.38) between the TC and TAp groups.
The available data on TC TAVI show comparable technical feasibility with other traditional access routes, representing a viable alternative. However, the paucity of data warrants the need for larger randomized controlled trials to establish a firm conclusion.
颈动脉是经导管主动脉瓣植入术（TAVI）的一种新型入路途径，对于不适合传统入路途径（包括经股动脉（TF）、锁骨下动脉、经心尖（TAp）和经主动脉（TAo））的患者尤为有用。本系统评价总结了经颈动脉行TAVI的有效性和安全性证据。
按照系统评价和Meta分析的首选报告规范（PRISMA）指南，在三个在线数据库（Medline（通过PubMed）、SCOPUS和Cochrane数据库）上进行了系统评价。
共纳入8项非随机对照试验，涉及四个TAVI血管入路部位的650例患者：经颈动脉（TC）（n = 364）、经股动脉（n = 100）、经心尖（n = 151）、经主动脉（n = 35）。TC-TAVI的30天死亡率和神经系统并发症发生率分别为6.5%和3.8%，心肌梗死发生率为1例。其他并发症包括血管并发症（7.7%）、植入新起搏器（17.4%）、心房颤动（5.2%）、急性肾损伤（6.9%）、出血事件（14.3%），其中13例（3.6%）为危及生命的情况；5例（1.4%）为严重情况；35例（9.3%）为轻微情况。随访至1年时又有19例死亡。TC组和TAp组在死亡率[风险比（RR）= 0.31，95%CI 0.05 - 1.79；p = 0.19]和开始透析治疗方面（RR = 2.53，95%CI 0.31 - 19.78；p = 0.38）无显著差异。
关于TC-TAVI的现有数据显示其技术可行性与其他传统入路途径相当，是一种可行的替代方案。然而，数据的匮乏需要进行更大规模的随机对照试验以得出确凿结论。
