Key result
A minimalist approach for TAVR reduced the risk of acute kidney injury (OR 0.49; 95% CI 0.27-0.89), major bleeding, and major vascular complications compared to standard care.
Why the study?
The shift in TAVR practice toward a minimalist approach remains an ongoing debate.
Does a minimalist approach improve clinical and procedural outcomes compared to standard care in patients undergoing TAVR?
Meta-Analysis (n=2,880)
Does a minimalist approach improve clinical and procedural outcomes compared to standard care in patients undergoing TAVR?
A minimalist approach to TAVR is associated with reduced procedural complications and shorter hospital stays without compromising mortality or readmission rates compared to standard care.
May support minimalist TAVR to reduce complications without mortality increase; leaves open confirmation by randomized trials.
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.
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Qureshi et al. (2021) conducted a meta-analysis in Transcatheter aortic valve replacement (TAVR) (n=2,880). Minimalist approach vs. Standard approach was evaluated on Acute kidney injury (OR 0.49, 95% CI 0.27-0.89). A minimalist approach for TAVR reduced the risk of acute kidney injury (OR 0.49; 95% CI 0.27-0.89), major bleeding, and major vascular complications compared to standard care.
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