To compare the safety and efficacy of COT vs. ST in terms of mortality, conduction disturbances, permanent pacemaker implantation (PPI), and cerebrovascular accidents (CVA).
Approach:
Systematic Review and Meta-Analysis: This study followed PRISMA guidelines and included studies comparing COT and ST, with data extraction and risk-of-bias assessment performed independently.
Key Findings:
COT significantly reduced mortality compared to ST (OR: 0.60, 95% CI: 0.40–0.88; p = 0.010).
COT resulted in lower conduction disturbances (OR: 0.62, 95% CI: 0.48–0.82; p = 0.0006).
The risk of permanent pacemaker implantation was reduced with COT (OR: 0.50, 95% CI: 0.39–0.63; p < 0.0001).
No significant difference in cerebrovascular accidents between groups (random-effects OR: 1.05, 95% CI: 0.73–1.51; p = 0.78).
Interpretation:
COT in self-expandable TAVR is associated with lower rates of conduction disturbances and PPI, and reduced short-term mortality, without increasing cerebrovascular risk.
Limitations:
The overall certainty of evidence is limited.
Further randomized studies are needed to confirm long-term benefits.
Conclusion:
COT appears to be a promising procedural refinement.
by Mohammad Ghannam, Mustafa Abomohsen, Iyad Y. Idries, Fayez Shamoon, Rahul Vasudev, Khaled Moghib, Muhammad Ghallab, Fawzi Zghyer, Alena V. González, Abdullah Ahmad, Habib A. Habib
