Abstract 15611: A Meta-Analysis of Major Adverse Cardiovascular and Cerebrovascular Events in Patients Undergoing Transfemoral versus Transapical Transcatheter Aortic Valve Implantation Using Edwards SAPIEN Valve for Severe Aortic Stenosis
Background: In patients with severe aortic stenosis (AS) who are high risk for surgery, a transcatheter aortic valve implantation (TAVI) is an emerged alternative procedure using transfemoral (TF) or transapical (TA) approach. The purpose of this meta-analysis is to compare early major adverse cardiovascular and cerebrovascular events (MACCE) 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. Eleven studies (n=2221) comparing TF-TAVI (n=1026) and TA-TAVI (n=1195) procedures using Edwards SAPIEN valve were included. End points were 1 year all-cause mortality, stroke, MI, bleeding and major vascular complications. 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 all outcomes except 1 year mortality outcome. There was no significant difference between TF-TAVI and TA-TAVI for 1 year mortality (OR: 0.73, CI: 0.34-1.57, p=0.41) (Figure A), incidence of stroke (OR: 1, CI: 0.62-1.62, p=0.99), MI (OR: 0.63, CI: 0.22-1.83, p=0.4) and bleeding events (OR: 0.85, CI: 0.54-1.32, p=0.47). The major vascular complications were significantly higher in TF-TAVI compared to TA-TAVI (OR: 4.91, CI: 3.43-7.04, p<0.00001) (Figure B).
Conclusion: The results of this meta-analysis of 2221 patients revealed that TA-TAVI had similar early MACCE as compared to TF-TAVI and was associated with lower major vascular complications. In patients with contraindications to TF-TAVI, TA-TAVI is a reasonable option. Further studies are needed to evaluate long-term clinical outcomes between TF-TAVI and TA-TAVI.
- © 2013 by American Heart Association, Inc.