Purpose: In most of the patients, Transcatheter Aortic Valve Implantation (TAVI) may be performed using transfemoral (TF) or transapical (TA) approach: however impact of access choice on periprocedural and mid-term results remains to be defined. Aim of our study was to evaluate the impact of access choice on short and mid-term follow-up after TAVI Methods: Medline and Cochrane Library were searched for articles describing differences in baseline, peri-procedural and mid-term outcomes among patients undergoing TF or TA TAVI. The primary end point was all-cause mortality at mid-term follow-up, while secondary ones 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: 13 studies with 10468 patients were included. TF was the most exploited strategy (69.5% vs. 30.5%). After adjusting for confounding variables, 30 days and follow-up mortality (median 365 days, range 222-400) were lower in TF patients with a pooled adjusted odds ratio of 0.81 [0.68-0.99 I2 99%] and 0.85 [0.80-0.90 I2 96%], respectively. Regarding periprocedural outcomes, TF reduced risk of bleedings and strokes (OR respectively of 0.74 [0.66-0.82 I2 95] and 0.91 [0.83-0.99) I2 86% respectively. Conclusions: TF approach reduces mortality in TAVI patients, due to lower rates of periprocedural bleedings and strokes.
Impact of access on TAVI procedural and midterm term follow up: a meta-analysis of 13 studies and 10468 patients
D'ASCENZO, FABRIZIO;GIORDANA, Francesca;GAITA, Fiorenzo;
2014-01-01
Abstract
Purpose: In most of the patients, Transcatheter Aortic Valve Implantation (TAVI) may be performed using transfemoral (TF) or transapical (TA) approach: however impact of access choice on periprocedural and mid-term results remains to be defined. Aim of our study was to evaluate the impact of access choice on short and mid-term follow-up after TAVI Methods: Medline and Cochrane Library were searched for articles describing differences in baseline, peri-procedural and mid-term outcomes among patients undergoing TF or TA TAVI. The primary end point was all-cause mortality at mid-term follow-up, while secondary ones 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: 13 studies with 10468 patients were included. TF was the most exploited strategy (69.5% vs. 30.5%). After adjusting for confounding variables, 30 days and follow-up mortality (median 365 days, range 222-400) were lower in TF patients with a pooled adjusted odds ratio of 0.81 [0.68-0.99 I2 99%] and 0.85 [0.80-0.90 I2 96%], respectively. Regarding periprocedural outcomes, TF reduced risk of bleedings and strokes (OR respectively of 0.74 [0.66-0.82 I2 95] and 0.91 [0.83-0.99) I2 86% respectively. Conclusions: TF approach reduces mortality in TAVI patients, due to lower rates of periprocedural bleedings and strokes.
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
