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

Abstract Background 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. Methods We conducted a computerized literature s...

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Bibliographic Details
Published in:Canadian journal of cardiology 2015-12, Vol.31 (12), p.1427-1438
Main Authors: Chandrasekhar, Jaya, MBBS, Hibbert, Benjamin, MD, PhD, Ruel, Marc, MD, Lam, Buu-Khanh, MD, Labinaz, Marino, MD, Glover, Christopher, MD
Format: Article
Language:English
Subjects:
Adult
Aortic Valve - surgery
Bicuspid Aortic Valve Disease
Cardiac Catheterization - methods
Cardiovascular
Cause of Death
Cohort Studies
Female
Femoral Artery
Heart Defects, Congenital - mortality
Heart Defects, Congenital - surgery
Heart Valve Diseases - mortality
Heart Valve Diseases - surgery
Heart Valve Prosthesis Implantation - methods
Humans
Male
Postoperative Complications - mortality
Risk Factors
Survival Rate
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Summary:Abstract Background 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. Methods 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. Results 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  = 0.91) compared with non-transfemoral access. The incidence of cerebrovascular events was similar in both groups (1.6% vs 2.1%; OR, 0.86; 95% CI, 0.64-1.15; P  = 0.31). Conclusions Transfemoral access was associated with lower rate of 30-day and 1-year mortality compared with non-transfemoral access for TAVI. Randomized studies are needed to ascertain the effect of alternative access sites on clinical outcomes in prohibitive-risk, high-risk, and intermediate-risk populations, using currently available technologies.
ISSN:0828-282X
1916-7075
DOI:10.1016/j.cjca.2015.04.023