Abstract
BackgroundSince 2002, transapical aortic valve replacement has been developed as a clinical pathway for transcatheter aortic valve implantation (TAVI). However the appropriate role of TA in the AS population versus TF remains unclear. We performed a meta-analysis to assess if TF has any benefit in reduction of 30-day clinical complications in AS.MethodsWe conducted a comprehensive search on pub-med and web of knowledge from 2002 through September 2012 using following terms: aortic stenosis, aortic valve replacement, transcatheter aortic valve implantation, TAVI, trans-artery, transfemoral, trans-apical. Studies in the original research or review articles were also considered. Included studies must meet the preconditioned criterias. Two investigators independently browsed the studies by title and abstract, finally making decision according to full-text. Disagreements were discussed in group.ResultsA total of 20 studies met inclusion criteria’s and were included in the analysis (including 4267 patients in TF group, 2242 in TA group). No random clinical trial, one was a retrospective study, others were prospective trials. Our meta-analysis found that TF had the low incidence of 30-day mortality compared with TA procedure (7.5% versus 11.3%). The incidence of stroke at ≤ 30 days was relatively low (3.8% in TF versus 4.0% in TA). Although the incidence of post-operative heart block was high (8.5% versus 7.5%), but no differences were indicated [1.06,95% CI(0.85,1.33)].ConclusionsThe result of our meta-analysis suggested that TF may have a low risk for 30-day mortality against TA procedure. No difference was found in the incidence of post-operative stroke and heart block.
Highlights
Since 2002, transapical aortic valve replacement has been developed as a clinical pathway for transcatheter aortic valve implantation (TAVI)
We conducted a meta-analysis with studies where only SAPIEN bovine valve was used, and indicated that our results were consistent
The Edwards-Sapien bioprosthesis has been approved for clinical use in the European Union and preliminary guidance for its use has been published by the National Institute of Clinical Excellence
Summary
Since 2002, transapical aortic valve replacement has been developed as a clinical pathway for transcatheter aortic valve implantation (TAVI). Surgical aortic valve replacement is the gold standard treatment for patients with aortic stenosis. Patients in high risk with severe, symptomatic aortic stenosis arenot candidates for surgical AVR. Since encouraging early results from various centers, TAVI is increasingly seen and accepted as an alternative procedure in high-risk patients [1,2,3]. The TF approach was used in 66% of procedures, but in case of small size and atheromatosis of the iliac arteries, this approach is not suitable. The transapical approach is usually applied for patients with small, calcified,iliac arteries. Patients with inadequate iliac access are usually considered asa high risk associated with bleeding, false aneurysm, or orther vascular complications, which critically influencing the outcome of the patient
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