title: A meta-analysis on clinical outcomes after transaortic transcatheter aortic valve implantation by the Heart Team.
abstract: OBJECTIVE
  We aimed to perform a meta-analysis on transaortic (TAo) transcatheter aortic valve implantation (TAVI) in order to gain more insight into the safety and efficacy of the approach in addition to the data available from selected centres with small numbers of patients.
  
  
  RESULTS
  PubMed and EMBASE were searched on 31 August 2016. The search yielded 251 studies, of which 16 with 1,907 patients were included in the meta-analysis. All were observational, single-arm studies. The rate of conversion to sternotomy was 3.2% (95% CI: 2.3-3.5%; I2=0) among nine studies. Device success among 10 studies was 91% (95% CI: 86.7-94.0%; I2=25.5). Major vascular complications occurred at a rate of 3.1% (95% CI: 1.6-6.0%; I2=60.8). Moderate or severe paravalvular leakage/aortic valve regurgitation (PVL/AR) was reported to be 6.7% (95% CI: 4.3-10.1%; I2=58.9). Permanent pacemaker implantation was required in 11.7% (95% CI: 9.2-14.8%; I2=26.5) of patients. Pooled 30-day post-TAVI complication rates were 9.9% (95% CI: 8.6-11.3%; I2=0) for mortality, 3.7% (95% CI: 2.4-5.6%; I2=28.7) for all stroke, and 1.0% for myocardial infarction (95% CI: 0.5-1.7%; I2=0). The Valve Academic Research Consortium-2 (VARC-2) composite safety endpoint occurred at a pooled rate of 16.7% (95% CI: 10.6-25.3%; I2=58.7).
  
  
  CONCLUSIONS
  In this meta-analysis of observational studies, transaortic TAVI appears to be a safe procedure with low complication rates.
authors.affiliation: Department of Cardiothoracic Surgery, Medisch Centrum Leeuwarden, Leeuwarden, the Netherlands.
authors.forename: Hafid
authors.initials: H
authors.lastname: Amrane
authors.forename: Fabiano
authors.initials: F
authors.lastname: Porta
authors.forename: Ad V
authors.initials: AV
authors.lastname: Van Boven
authors.forename: A Pieter
authors.initials: AP
authors.lastname: Kappetein
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Head
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D064887:Observational Studies as Topic; D010348:Patient Care Team; D061214:Patient Safety; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome