title: 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 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.
authors: University of Ottawa Heart Institute, CAPITAL Research Group, Division of Cardiology, Ottawa, Ontario, Canada.
authors: Jaya
authors: J
authors: Chandrasekhar
authors: University of Ottawa Heart Institute, CAPITAL Research Group, Division of Cardiology, Ottawa, Ontario, Canada.
authors: Benjamin
authors: B
authors: Hibbert
authors: Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address: mruel@ottawaheart.ca.
authors: Marc
authors: M
authors: Ruel
authors: Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors: Buu-Khanh
authors: BK
authors: Lam
authors: University of Ottawa Heart Institute, CAPITAL Research Group, Division of Cardiology, Ottawa, Ontario, Canada.
authors: Marino
authors: M
authors: Labinaz
authors: University of Ottawa Heart Institute, CAPITAL Research Group, Division of Cardiology, Ottawa, Ontario, Canada.
authors: Christopher
authors: C
authors: Glover
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D006328:Cardiac Catheterization / Q000379:methods*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005263:Femoral Artery; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate