Meta-Analysis Comparing Percutaneous to Surgical Access in Trans-Femoral Transcatheter Aortic Valve Implantation

• Published in: The American journal of cardiology Vol. 125; no. 8; pp. 1239 - 1248
• Main Authors: Abdelaziz, Hesham K., Megaly, Michael, Debski, Maciej, Rahbi, Hazim, Kamal, Diaa, Saad, Marwan, Wiper, Andrew, More, Ranjit, Roberts, David H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.04.2020; Elsevier Limited
• Subjects: Aorta; Aortic valve; Bias; Bleeding; Blood transfusion; Blood transfusions; Body mass index; Cerebral infarction; Clinical trials; Collaboration; Complications; Confidence intervals; Consortia; Femur; Heart attacks; Heart valves; Hospitals; Implantation; Meta-analysis; Mortality; Myocardial infarction; Renal failure; Surgical implants; Transfusion
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2020.01.021

To compare the outcomes in trans-femoral transcatheter aortic valve implantation (TF-TAVI) performed with percutaneous approach (PC) versus surgical cut-down (SC). In 13 trials including 5,859 patients (PC = 3447, SC = 2412), the outcomes based on Valve Academic Research Consortium criteria were compared between PC and SC in TF-TAVI. Compared with SC, PC was associated with similar major vascular complications (VCs) (8.7% vs 8.5%; odds ratio [OR] = 0.93, 95% confidence interval [CI] = 0.76 to 1.15, p = 0.53), major bleeding (OR = 1.09, 95% CI = 0.66 to 1.8, p = 0.73), perioperative mortality (5.7% vs 5.2%; OR = 1.13, 95% CI = 0.85 to 1.49, p = 0.4), urgent surgical repair (OR = 1.27, 95% CI = 0.81 to 2.02, p = 0.3), stroke (3.3% vs 3.9%; OR = 0.85, 95% CI = 0.53 to 1.36, p = 0.5), myocardial infarction (1.3% vs 1.1%; OR = 1.06, 95% CI = 0.53 to 2.12, p = 0.86), and renal failure (5.2% vs 5.9%; OR = 0.68, 95% CI = 0.38 to 1.22, p = 0.2), but shorter hospital stay (9.1 ± 8.5 vs 9.6 ± 9.5 days; mean difference = -1.07 day, 95% CI = -2.0 to -0.15, p = 0.02) and less blood transfusion (18.5% vs 25.7%; OR = 0.61, 95% CI = 0.43-0.86, p = 0.005). Minor VCs occurred more frequently in PC compared to SC (11.9% vs 6.9%; OR = 1.67, 95% CI = 1.04-2.67, p = 0.03). In conclusion, in TF-TAVI, PC is a safe and feasible alternative to SC, and adopting either approach depends on operator experience after ensuring that vascular access could be safely achieved with that specific technique.