Impact of carotid artery stenosis on outcomes of transcatheter aortic valve replacement: A systematic review and meta-analysis.

INTRODUCTION: Carotid Artery Stenosis (CAS) is common in elderly patients undergoing Transcatheter Aortic Valve Replacement (TAVR). However, the impact of CAS on the outcomes of TAVR is unclear. PURPOSE: This systematic review and meta-analysis aimed to compare the clinical and periprocedural outcomes in patients with and without CAS undergoing TAVR. METHODS: PubMed, Embase, and Cochrane databases were searched until February 2023. We included studies that performed a direct comparison of outcomes of TAVR in CAS versus non-CAS patients. Data was extracted from published reports and the ROBINS-I tool was utilized for quality assessment. The R studio software (version 4.2.2) was adopted for statistical analysis. RESULTS: Five observational studies and 111.915 patients were included. The mean age was 80.7 ± 8.2 years and 46.3% were female. The risk of stroke or transient ischemic attack was elevated in the group of patients with CAS (OR 1.44; 95% CI 1.07-1.95; p = 0.016). In contrast, myocardial infarction (OR 1.24; 95% CI 1.05-1.47; p = 0.074) and all-cause mortality (OR 0.99; 95% CI 0.73-1.35; p = 0.95) were not significantly different between CAS and non-CAS groups. Acute kidney injury and new pacemaker implantation did not differ between patients with and without CAS. CONCLUSIONS: Our findings suggest that CAS is significantly associated with cerebrovascular events in patients undergoing TAVR, without significantly impacting all-cause mortality. Further prospective studies are needed for a more granular assessment of additional determinants of this association, such as unilateral vs. bilateral involvement and whether there is a threshold of CAS severity for increased risk.

Venoarterial extracorporeal membrane oxygenation versus impella for cardiogenic shock in acute myocardial infarction: a systematic review and meta-analysis

BACKGROUND: Acute myocardial infarction (AMI) is an important cause of cardiogenic shock (CS). There is lack of evidence regarding the safety and efficacy of venoarterial extracorporeal membrane oxygenation (VA-ECMO) compared with Impella in this population. METHODS: We systematically searched PubMed, EMBASE, and Cochrane Library for studies comparing VA-ECMO with Impella in patients with CS related to AMI. The systematic review and meta-analysis followed Cochrane recommendations and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We used R version 4.3.1 for all statistical analyses. Odds ratios (OR) and 95% confidence intervals (CI) were pooled with a random-effects model. RESULTS: We included seven observational studies with 15.903 patients, of whom 12.943 (81.3%) were treated with Impella. There was no significant difference between groups regarding in-hospital mortality (OR 0.79; 95% CI 0.37-1.69; p=0.54; Figure 1A), ischemic stroke (OR 0.69; 95% CI 0.14-3.35; p=0.64; Figure 1B), acute kidney injury (OR 1.22; 95% CI 0.55-2.70; p=0.62), renal replacement therapy or dialysis (OR 1.02; 95% CI 0.33-3.19; p=0.97; Figure 1C), and blood transfusion (OR 0.52; 95% CI 0.16-1.72; p=0.28). CONCLUSION: In this meta-analysis, there was no significant difference between VA-ECMO and Impella among patients with CS and AMI for the outcomes of in-hospital mortality, ischemic stroke, acute kidney injury, renal replacement therapy, or blood transfusion.