Conrotto Federico, D'Ascenzo Fabrizio, Francesca Giordana, Colaci Chiara, Sacciatella Paolo, Biondi-Zoccai Giuseppe, Moretti Claudio, D'Amico Maurizio, Gaita Fiorenzo, Marra Sebastiano
Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy.
J Interv Cardiol. 2014 Oct;27(5):500-8. doi: 10.1111/joic.12141. Epub 2014 Sep 5.
Transcatheter aortic valve implantation (TAVI) may be performed using the transfemoral (TF) or transapical (TA) approach in most patients with aortic stenosis. The impact of access choice on peri-procedural and midterm results remains to be defined.
Medline and Cochrane Library were searched for articles describing differences in baseline, peri-procedural, and midterm outcomes among patients undergoing TF or TA TAVI. The primary end-point was all-cause mortality after at least 1-year follow-up, while secondary end-points were 30 days mortality and in-hospital complications (bleeding and cerebrovascular events). The independent impact of access choice was evaluated with pooled analysis using a random-effect model.
Thirteen studies with 10,468 patients were included. TF was the most exploited strategy (69.5% vs. 30.5%). After adjusting for confounding variables, 30-day and midterm follow-up mortality (median 365 days, range 222-400) were lower in TF patients with a pooled adjusted odds ratio of 0.81 (0.68-0.97 I(2) 99%) and 0.85 (0.80-0.90 I(2) 96%), respectively. Regarding periprocedural outcomes, TF reduced risk of bleedings and strokes (OR of 0.74 [0.66-0.82 I(2) 95%] and 0.91 [0.83-0.99] I(2) 86%, respectively).
The TF approach reduces mortality in TAVI patients, due to lower rates of periprocedural bleedings and strokes.
对于大多数主动脉瓣狭窄患者，可采用经股动脉（TF）或经心尖（TA）途径进行经导管主动脉瓣植入术（TAVI）。入路选择对围手术期和中期结果的影响仍有待确定。
检索Medline和Cochrane图书馆，查找描述接受TF或TA TAVI患者的基线、围手术期和中期结果差异的文章。主要终点是至少1年随访后的全因死亡率，次要终点是30天死亡率和住院并发症（出血和脑血管事件）。使用随机效应模型进行汇总分析，评估入路选择的独立影响。
纳入13项研究，共10468例患者。TF是最常用的策略（69.5%对30.5%）。在调整混杂变量后，TF患者的30天和中期随访死亡率（中位数365天，范围222 - 400天）较低，汇总调整后的优势比分别为0.81（0.68 - 0.97，I² 99%）和0.85（0.80 - 0.90，I² 96%）。关于围手术期结果，TF降低了出血和中风风险（优势比分别为0.74 [0.66 - 0.82，I² 95%]和0.91 [0.83 - 0.99]，I² 86%）。
由于围手术期出血和中风发生率较低，TF途径降低了TAVI患者的死亡率。
