Abstract 15584: Thirty-Day All-Cause Mortality in Patients Undergoing Transcatheter Aoritc Valve Implantation Using Edwards SAPIEN Valve for Severe Aortic Stenosis: A Meta-Analysis of Transfemoral versus Transapical Approach
Background: In patients with severe aortic valve stenosis (AS) who are high risk for surgical aortic valve replacement, transcatheter aortic valve implantation (TAVI) is an emerged alternative procedure. Transfemoral (TF) approach is usually used as an initial approach and Transapical (TA) approach is used when there are contraindications to TF approach. The objective of this meta-analysis is to compare procedure related all-cause mortality between TF-TAVI and TA-TAVI performed using Edwards SAPIEN valve.
Methods: PubMed, EMBASE, and the Cochrane Center Register of Controlled Trials were searched through April 2013. Ten studies (n=2221) comparing TF-TAVI (n=1026) and TA-TAVI (n=1195) procedures using Edwards SAPIEN valve were included. End points were in-hospital and 30 day all-cause mortality. The odds ratio (OR) with 95% confidence interval (CI) was computed and p<0.05 was considered as a level of significance.
Results: The studies were homogeneous for both outcomes. There was no significant difference between TF-TAVI and TA-TAVI for in-hospital all-cause mortality (OR: 1.25, CI: 0.55-2.85, p=0.59). Thirty day all-cause mortality was significantly lower in TF-TAVI compared to TA-TAVI (OR: 0.63, CI: 0.47-0.85, p=0.003) (Figure).
Conclusion: The results of our meta-analysis of 2221 patients suggest that TA-TAVI is associated with higher peri-procedural all-cause mortality compared to TF-TAVI performed using Edwards SAPIEN valve in patients with severe AS. The results of this study indicates that TF-TAVI would be the initial procedure of choice unless contraindicated. Further studies are needed to evaluate long-term mortality outcomes between TF-TAVI and TA-TAVI.
- © 2013 by American Heart Association, Inc.