Abstract 373: Meta-analysis of Clinical Outcomes Comparing Use of Transesophageal Echocardiography versus No Transesophageal Echocardiogram During Transcatheter Aortic Valve Replacement

Abstract

Background: Transesophageal echocardiography (TEE) is routinely used for intraoperative guidance for TAVR procedures. TAVR is also done with minimal imaging or no TEE guidance (minimal imaging approach). The clinical benefits of intraprocedure TEE during TAVR compared to minimal imaging approach has not been well established. Aim: To perform a meta-analysis of available trials comparing effectiveness of intraprocedural TEE versus minimal imaging approach during TAVR procedure. Hypothesis: TAVR with intraprocedural TEE is associated with better clinical outcomes compared with minimalist imaging approach. Methods: 8 retrospective observational studies were identified via a comprehensive literature search that incorporated Embase, MEDLINE, and CENTRAL. Each selected study reported on the comparison between TAVR performed with TEE guidance or with no TEE (minimalist strategy) during the procedure. Studies were screened for risk of bias using a quality assessment tool. Outcomes studied included all-cause mortality, cardiovascular mortality, paravalvular leak as defined by the original trial, readmission within 30 days, stroke, myocardial infarction (MI) , and acute kidney injury (AKI). For each outcome, estimates were pooled and reported as a risk ratio with 95% confidence interval (CI). Results: A total of 2057 patients were divided into TEE (n=1115) vs. non-TEE (n=942) cohorts. No significant difference was seen between TEE vs non-TEE groups in reducing cardiovascular mortality (RR=2.06 [95%CI: 0.91- 4.67], p=0.08 ), all cause mortality (RR= 0.63 [95% CI: 0.21- 1.90], p=0.41), readmission within 30 days (RR=0.49 [95% CI: 0.06-4.41], p=0.53), stroke (RR=0.97 [95% CI: 0.27- 3.47], p=0.96), MI (RR=0.92 [95%CI: 0.26- 3.29], p=0.90), and AKI (RR=1.24 [95% CI: 0.16-9.35], p=0.83). A significant increase in paravalvular leak was observed within the non-TEE group (RR=1.19 [95% CI: 1.01-1.39], p=0.04) in comparison to the TEE group. Conclusion: TEE guidance during TAVR is associated with reduced paravalvular leak when compared with minimal imaging approach. No other clinical difference was observed between the two approaches. Further studies are needed to validate these findings.