Transthoracic vs. transesophageal echocardiography in transcatheter aortic valve implantation: a systematic review and meta-analysis

Abstract

Aim: Traditionally, transcatheter aortic valve implantation (TAVI) was performed under general anesthesia (GA) accompanied by intraprocedural transesophageal echocardiography (TEE). Recently, minimalist TAVI with monitored anesthesia care (MAC) and transthoracic echocardiography (TTE) has gained popularity. However, TTE imaging quality may be suboptimal compared to TEE and may increase the risks of paravalvular leak (PVL). We sought to compare TTE to TEE for PVL (primary outcome) and secondary safety outcomes in a study-level meta-analysis.

Methods: Ovid versions of Medline and Embase were searched from 1946 to 2018 for studies comparing TTE to TEE in TAVI directly or MAC to GA in TAVI (must also specify echocardiography usage) and meta-analyzed in a random effects model.

Results: Sixteen studies (n = 3,510) were included in the meta-analysis. The rate of any PVL was not significantly different between TTE-TAVI and TEE-TAVI groups (18.4% vs. 21.4%, risk ratio: 1.01, 95%CI: 0.83 to 1.23, P = 0.92, I2 = 36%). Similarly, there were no significant differences in secondary safety outcomes. Resource utilization was lower with TTE-TAVI; hospital LOS [mean difference (MD): -1.55 days, 95%CI: -2.27 to -0.83, P < 0.01], contrast volume (MD: -24.75 mL, 95%CI: -49.48 to -0.03, P = 0.05) and procedure time (MD: -31.09 min, 95%CI: -54.77 to -7.40, P < 0.01) were significantly lower.

Conclusion: The use of TTE-TAVI in conjunction with MAC was not associated with an increased risk of PVL and was associated with lower hospital resource utilization. However, other factors, such as mode of anesthesia, may have influenced these findings.

Keywords

Transcatheter aortic valve implantation / transthoracic echocardiography / transesophageal echocardiography

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