title: A meta-analysis of mortality and major adverse cardiovascular and cerebrovascular events in patients undergoing transfemoral versus transapical transcatheter aortic valve implantation using edwards valve for severe aortic stenosis.
abstract: The purpose of this meta-analysis was to compare 1 year mortality and major adverse cardiovascular and cerebrovascular events between transfemoral (TF) transcatheter aortic valve implantation (TAVI) and transapical (TA) TAVI performed using Edwards valves. PubMed, Embase, and the Cochrane Center Register of Controlled Trials were searched for studies published from January 2000 through March 2014. Seventeen studies met the inclusion criteria and were included in the analysis. This meta-analysis included total of 2,978 patients with severe aortic stenosis not eligible for traditional surgical procedures who underwent TF TAVI (n = 1,465) or TA TAVI (n = 1,513). End points were in-hospital, 30-day, and 1-year all-cause mortality, stroke, myocardial infarction, major bleeding, and major vascular complications. Odds ratios (ORs) with 95% confidence interval (CIs) were computed, and p values <0.05 were considered to indicate statistical significance. The studies were homogenous for all outcomes except 1-year mortality. There was no significant difference between the TF and TA TAVI groups for 1-year mortality (OR 0.64, 95% CI 0.34 to 1.2, p = 0.16), incidence of stroke (OR 1.14, 95% CI 0.76 to 1.71, p = 0.52), incidence of myocardial infarction (OR 0.62, 95% CI 0.23 to 1.7, p = 0.35), and incidence of bleeding events (OR 0.76, 95% CI 0.51 to 1.14, p = 0.19). Thirty-day all-cause mortality was significantly less with TF TAVI compared with TA TAVI (OR 0.59, 95% CI 0.45 to 0.76, p <0.0001). Major vascular events were significantly higher in the TF TAVI group compared with the TA TAVI group (OR 4.33, 95% CI 3.14 to 5.97, p <0.00001). In conclusion, the results of this meta-analysis of 2,978 patients revealed that TA TAVI had similar 1-year major adverse cardiovascular and cerebrovascular events, fewer major vascular complications, but higher 30-day mortality compared with TF TAVI. In patients with contraindications to TF TAVI, TA TAVI is a reasonable option, although further randomized trials are warranted for evaluating long-term clinical outcomes between TF and TA TAVI.
authors.affiliation: Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee.
authors.forename: Hemang B
authors.initials: HB
authors.lastname: Panchal
authors.affiliation: Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee.
authors.forename: Vatsal
authors.initials: V
authors.lastname: Ladia
authors.affiliation: Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee.
authors.forename: Parthiv
authors.initials: P
authors.lastname: Amin
authors.affiliation: Department of Pathology, University of Tennessee, Knoxville, Tennessee.
authors.forename: Parthavkumar
authors.initials: P
authors.lastname: Patel
authors.affiliation: Division of Epidemiology, Department of Preventive Medicine and Community Health, University of Texas Medical Brach, Galveston, Texas.
authors.forename: Sreenivas P
authors.initials: SP
authors.lastname: Veeranki
authors.affiliation: Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee.
authors.forename: Kais
authors.initials: K
authors.lastname: Albalbissi
authors.affiliation: Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee. Electronic address: pault@etsu.edu.
authors.forename: Timir
authors.initials: T
authors.lastname: Paul
mesh_terms: D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D005263:Femoral Artery; D014943:Global Health; D006325:Heart Atria; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D015996:Survival Rate / Q000639:trends; D013927:Thrombosis / Q000453:epidemiology* / Q000209:etiology; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*