title: Impact of access on TAVI procedural and midterm follow-up: a meta-analysis of 13 studies and 10,468 patients.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) may be performed using the transfemoral (TF) or transapical (TA) approach in most patients with aortic stenosis. The impact of access choice on peri-procedural and midterm results remains to be defined.
  
  
  METHODS
  Medline and Cochrane Library were searched for articles describing differences in baseline, peri-procedural, and midterm outcomes among patients undergoing TF or TA TAVI. The primary end-point was all-cause mortality after at least 1-year follow-up, while secondary end-points were 30 days mortality and in-hospital complications (bleeding and cerebrovascular events). The independent impact of access choice was evaluated with pooled analysis using a random-effect model.
  
  
  RESULTS
  Thirteen studies with 10,468 patients were included. TF was the most exploited strategy (69.5% vs. 30.5%). After adjusting for confounding variables, 30-day and midterm follow-up mortality (median 365 days, range 222-400) were lower in TF patients with a pooled adjusted odds ratio of 0.81 (0.68-0.97 I(2) 99%) and 0.85 (0.80-0.90 I(2) 96%), respectively. Regarding periprocedural outcomes, TF reduced risk of bleedings and strokes (OR of 0.74 [0.66-0.82 I(2) 95%] and 0.91 [0.83-0.99] I(2) 86%, respectively).
  
  
  CONCLUSIONS
  The TF approach reduces mortality in TAVI patients, due to lower rates of periprocedural bleedings and strokes.
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Conrotto
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.forename: Giordana
authors.initials: G
authors.lastname: Francesca
authors.forename: Chiara
authors.initials: C
authors.lastname: Colaci
authors.forename: Paolo
authors.initials: P
authors.lastname: Sacciatella
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.forename: Maurizio
authors.initials: M
authors.lastname: D'Amico
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Marra
mesh_terms: D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D020521:Stroke / Q000453:epidemiology; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*