Meta-Analysis Comparing Percutaneous to Surgical Access in Trans-Femoral Transcatheter Aortic Valve Implantation

Abstract To compare the outcomes in trans-femoral transcatheter aortic valve implantation (TF-TAVI) performed with percutaneous approach (PC) versus surgical cut-down (SC). In 13 trials including 5859 patients (PC=3447, SC= 2412), the outcomes based on Valve Academic Research Consortium (VARC) criteria were compared between PC and SC in TF-TAVI. Compared with SC, PC was associated with similar major vascular complications (VCs) (8.7% vs. 8.5%; OR=0.93, 95% CI=0.76-1.15, p=0.53), major bleeding (OR=1.09, 95% CI=0.66-1.8, p=0.73), perioperative mortality (5.7% vs. 5.2%; OR=1.13, 95% CI=0.85-1.49, p=0.4), urgent surgical repair (OR=1.27, 95% CI=0.81-2.02, p=0.3), stroke (3.3% vs. 3.9%; OR=0.85, 95% CI=0.53-1.36, p=0.5), myocardial infarction (1.3% vs.1.1%; OR=1.06, 95% CI=0.53-2.12, p=0.86), and renal failure (5.2% vs. 5.9%; OR=0.68, 95% CI=0.38-1.22, p=0.2), but shorter hospital stay (9.1±8.5 vs 9.6±9.5 days; mean difference= -1.07 day, 95% CI=-2.0 to -0.15, p=0.02) and less blood transfusion (18.5% vs. 25.7%; OR=0.61, 95% CI=0.43-0.86, p=0.005). Minor VCs occurred more frequently in PC compared to SC (11.9% vs. 6.9%; OR=1.67, 95% CI=1.04-2.67, p=0.03). In conclusion, in TF-TAVI, PC is a safe and feasible alternative to SC, and adopting either approach depends on operator experience after ensuring that vascular access could be safely achieved with that specific technique.