Author + information
- Muhammad S. Azzouz,
- Toufik Mahfood Haddad,
- Abhilash Akinapelli,
- Aiman Smer,
- Mark Woodruff,
- Michael Del Core and
- Michael White
Transcatheter aortic valve implantation (TAVI) is a breakthrough treatment option for inoperable or high surgical risk patients with symptomatic, severe aortic valve disease. Traditionally Trans-Femoral (TF) access has been the most common route. Trans-Apical (TA) access has been used since 2004 as an alternative in patients with unfavorable anatomy. We conducted a meta-analysis to compare between these two approaches.
We searched PubMed, Cochrane Library and Web of Science databases for randomized studies comparing TF versus TA access in TAVI patients between 2002-2015 using the search terms: Transcatheter aortic valve replacement, TAVR, TAVI, trans-femoral, and trans-apical. The primary outcome assessed was 30-day mortality. We also evaluated the risks of the following postoperative conditions: stroke, heart block, bleeding and renal failure. We conducted our meta-analysis using RevMan 5.3 software with random effects model. Visual inspection of the funnel plot showed no publication bias. P value less than 0.05 was considered statistically significant.
A total of 24 randomized studies with a total of 8581 patients (TF:5693; TA: 2888) were included in the final analysis. TF patients had less 30-day mortality (OR: 0.57[0.38-0.87]) compared to TA patients. Bleeding (OR: 0.6 [0.49-0.73]) and renal failure (OR: 0.33 [0.24-0.46]) were less in the TF arm as well. There was no statistically significant difference in the rate of stroke or heart block between both groups. A sensitivity analysis was performed and confirmed the above mentioned results.
TF approach has less 30-day mortality, bleeding complications, and renal failure as compared with the TA approach. One should be mindful though that the TA approach is usually saved for patient with extensive comorbidities which may be contribute to these differences.