Key result
Protocol outlines planned meta-analysis of remote ischaemic preconditioning in TAVR.
Why the study?
TAVR-related complications still increase morbidity and mortality, and the efficacy of remote ischaemic preconditioning in TAVR remains unclear due to inconsistent conclusions across clinical studies.
Does remote ischaemic preconditioning reduce early all-cause mortality in patients undergoing transcatheter aortic valve replacement?
Systematic Review
Does remote ischaemic preconditioning reduce early all-cause mortality in patients undergoing transcatheter aortic valve replacement?
This protocol outlines a planned systematic review and meta-analysis to evaluate whether remote ischaemic preconditioning provides clinical benefit and reduces mortality or complications in patients undergoing transcatheter aortic valve replacement.
No new evidence on RIPC for TAVR yet; protocol leaves efficacy question open pending planned synthesis.
INTRODUCTION: Transcatheter aortic valve replacement (TAVR) has become an important treatment in patients with aortic valve disease with the continuous advancement of technology and the improvement of outcomes. However, TAVR-related complications still increase patient morbidity and mortality. Remote ischaemic preconditioning (RIPC) is a simple procedure that provides perioperative protection for many vital organs. However, the efficiency of RIPC on TAVR remains unclear based on inconsistent conclusions from different clinical studies. Therefore, we will perform a protocol for a systematic review and meta-analysis to identify the efficiency of RIPC on TAVR. METHODS AND ANALYSIS: English databases (PubMed, Web of Science, Ovid Medline, Embase and Cochrane Library), Chinese electronic databases (Wanfang Database, VIP Database and China National Knowledge Infrastructure) and trial registry databases will be searched from inception to December 2023 to identify randomised controlled trials of RIPC on TAVR. We will calculate mean differences or standardised mean differences with 95% CIs for continuous data, and the risk ratio (RR) with 95% CIs for dichotomous data by Review Manager version 5.4. Fixed-effects model or random-effects model will be used according to the degree of statistical heterogeneity assessed by the I-square test. We will evaluate the risk of bias using the Cochrane risk-of-bias tool 2 and assess the evidence quality of each outcome by the Grading of Recommendations Assessment, Development and Evaluation. The robustness of outcomes will be evaluated by trial sequential analysis. In addition, we will evaluate the publication bias of outcomes by Funnel plots and Egger's regression test. ETHICS AND DISSEMINATION: Ethical approval was not required for this systematic review protocol. The results will be disseminated through peer-reviewed publications. PROSPERO REGISTRATION NUMBER: CRD42023462926.
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Zhang et al. (2024) conducted a systematic review in aortic valve disease requiring transcatheter aortic valve replacement (TAVR). Remote ischaemic preconditioning (RIPC) vs. TAVR without RIPC was evaluated on Early all-cause mortality (in-hospital mortality and 30-day mortality). This paper is a protocol for a systematic review and meta-analysis to evaluate the clinical efficacy of remote ischaemic preconditioning for transcatheter aortic valve replacement, and thus contains no results.
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