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Lam et al. Vessel Plus 2019;3:27 Vessel Plus
DOI: 10.20517/2574-1209.2019.009

Meta-Analysis Open Access

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

Tiffany K. Lam , Derrick Y. Tam , Apurva R. Dixit , Stephen E. Fremes 2
3
1
2
1 Department of Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada.
2 Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of
Toronto, Toronto, ON M4N 3M5, Canada.
3 Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada.

Correspondence to: Dr. Stephen E. Fremes, Dr. Bernard S. Goldman Chair in Cardiovascular Surgery, Schulich Heart Centre,
Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room H4 05, Toronto, ON M4N 3M5, Canada.
E-mail: stephen.fremes@sunnybrook.ca

How to cite this article: Lam TK, Tam DY, Dixit AR, Fremes SE. Transthoracic vs. transesophageal echocardiography in
transcatheter aortic valve implantation: a systematic review and meta-analysis. Vessel Plus 2019;3:27.
http://dx.doi.org/10.20517/2574-1209.2019.009

Received: 12 Apr 2019 First Decision: 6 Jul 2019 Revised: 15 Jul 2019 Accepted: 19 Jul 2019 Published: 7 Aug 2019

Science Editor: Mario F. L. Gaudino Copy Editor: Cai-Hong Wang Production Editor: Tian Zhang

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, I 2
= 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.

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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and indicate if changes were made.

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