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Approaches for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Nagaraja, V and Raval, J and Eslick, GD and Denniss, AR (2014) Approaches for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. [Journal (On-line/Unpaginated)]

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Abstract

Introduction: Retrograde transfemoral and antegrade transapical approaches are mostly used for transcatheter aortic valve replacement. This meta-analysis is designed to assess the performance of the transfemoral and transapical approach. Methods: A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane library, Google Scholar, Science Direct, and Web of Science. Original data was abstracted from each study and used to calculate a pooled odd ratio (OR) and 95% confidence interval (95% CI). Results: Only 14 studies comprising of 6965 patients met full criteria for analysis. The mean duration of hospitalisation and procedure duration were similar among the 2 cohorts. The 30 days mortality (OR: 0.70, 95% CI: 0.531-0.921), the need for haemodialysis (OR: 0.29, 95% CI: 0.157-0.525) and one year mortality (OR: 0.72, 95% CI: 0.564-0.927) were lower in the transfemoral cohort. The frequency of stroke at 30 days and new pacemaker insertion were comparable. However, the prevalence of vascular complication (OR: 2.88, 95% CI: 1.821-4.563) was higher in the transfemoral group. The incidence of aortic regurgitation (OR: 1.25, 95% CI: 0.844-1.855), valve embolization (OR: 2.00, 95% CI: 0.622-6.448), major bleeding incidence rates (OR:0.77, 95% CI: 0.488-1.225), coronary obstruction (OR:0.74, 95% CI:0.234-2.311), myocardial infarction (OR: 0.75, 95% CI: 0.28-2.00), conversion to open cardiac surgery (OR: 0.29, 95% CI: 0.062-1.343) and successful implantation (OR: 0.67, 95% CI: 0.394-1.149) were comparable in the two cohorts. Conclusions: In the absence of a randomized controlled study, the ability to discriminate true differences is challenging. Even though the complications rate was much lower in transfemoral group as compared to transapical group, the current literature does not support a clear superiority of one approach to TAVR over the other.

Item Type:Journal (On-line/Unpaginated)
Keywords:Transcatheter aortic valve replacement; Access approaches; Transfemoral; Transapical; Aortic stenosis
Subjects:JOURNALS > Online Journal of Health and Allied Sciences
ID Code:9710
Deposited By: Kakkilaya Bevinje, Dr. Srinivas
Deposited On:21 Feb 2015 14:35
Last Modified:20 Apr 2015 11:44

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