title: Percutaneous versus surgical cut-down access in transfemoral transcatheter aortic valve replacement: A meta-analysis.
abstract: BACKGROUND
  The transfemoral (TF) approach has become the preferred approach for transcatheter aortic valve replacement (TAVR) because of its low risk profile. However, the relative safety of the percutaneous approach (PC) compared to surgical cut-down (SC) remains unclear. Our aim was to compare the outcomes between PC versus SC access in patients undergoing TF-TAVR using a meta-analysis.
  
  
  METHODS
  We conducted a systematic electronic database search for studies reporting major and minor vascular complications (VC), major and minor bleeding, and perioperative all-cause mortality, in PC versus SC TF-TAVR cases. Complications were reported based on the Valve Academic Research Consortium criteria. A random-effects model was used to calculate odds ratios and 95% confidence intervals.
  
  
  RESULTS
  Eight observational cohort studies and one randomized control trial (2513 patients in PC and 1767 patients in SC) were included in the analysis. Major and minor VC, as well as bleeding complications, were comparable between the two approaches. The need for surgical intervention for VC was comparable between PC and SC. There was no difference in perioperative all-cause mortality.
  
  
  CONCLUSIONS
  PC and SC have similar safety profiles and outcomes when used appropriately in selected patients.
authors.affiliation: Department of Internal Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Tomo
authors.initials: T
authors.lastname: Ando
authors.affiliation: Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Briasoulis
authors.affiliation: Leon H. Charney Division of Cardiology, NYU Langone Medical Center, New York, New York.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Holmes
authors.affiliation: Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
authors.forename: Hisato
authors.initials: H
authors.lastname: Takagi
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.|Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: David P
authors.initials: DP
authors.lastname: Slovut
mesh_terms: D015331:Cohort Studies; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D064887:Observational Studies as Topic; D011183:Postoperative Complications / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000453:epidemiology