Transfemoral vs Non-transfemoral Access for Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis

The Canadian Journal of Cardiology
Jaya ChandrasekharChristopher Glover

Abstract

Transcatheter aortic valve implantation (TAVI) is the definitive therapy for high-risk patients with severe aortic stenosis. The aim of this study was to determine the effect of non-transfemoral access on clinical outcomes in TAVI. We conducted a computerized literature search on SCOPUS and selected all studies published in the English language, from 2002 until March 12 2014, that compared transfemoral access with a non-transfemoral access cohort. Two independent reviewers evaluated the studies and extracted data for analysis. A total 17,020 patients (11,079 transfemoral, 5941 non-transfemoral) encompassing 28 studies underwent TAVI between 2007 to 2013. Overall, the 30-day mortality was 4.7% with the transfemoral approach and 8.1% with a non-transfemoral approach (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.49-0.64; P < 0.01). The 1-year mortality was 16.4% with transfemoral access and 24.8% with non-transfemoral access (OR, 0.68; 95% CI, 0.60-0.75; P < 0.01). Transfemoral access was associated with a greater incidence of vascular complications (OR, 2.1; 95% CI, 1.48-2.99; P < 0.01) but a lower rate of surgical conversion (OR, 0.59; 95% CI, 0.42-0.81; P < 0.01) and similar bleeding (OR, 1.01; 95% CI, 0.81-1.27; P = ...Continue Reading

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