Chandrasekhar Jaya, Hibbert Benjamin, Ruel Marc, Lam Buu-Khanh, Labinaz Marino, Glover Christopher
University of Ottawa Heart Institute, CAPITAL Research Group, Division of Cardiology, Ottawa, Ontario, Canada.
Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Can J Cardiol. 2015 Dec;31(12):1427-38. doi: 10.1016/j.cjca.2015.04.023. Epub 2015 Apr 30.
Transcatheter aortic valve implantation (TAVI) is the definitive therapy for high-risk patients with severe aortic stenosis. The aim of this study was to determine the effect of non-transfemoral access on clinical outcomes in TAVI.
We conducted a computerized literature search on SCOPUS and selected all studies published in the English language, from 2002 until March 12 2014, that compared transfemoral access with a non-transfemoral access cohort. Two independent reviewers evaluated the studies and extracted data for analysis.
A total 17,020 patients (11,079 transfemoral, 5941 non-transfemoral) encompassing 28 studies underwent TAVI between 2007 to 2013. Overall, the 30-day mortality was 4.7% with the transfemoral approach and 8.1% with a non-transfemoral approach (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.49-0.64; P < 0.01). The 1-year mortality was 16.4% with transfemoral access and 24.8% with non-transfemoral access (OR, 0.68; 95% CI, 0.60-0.75; P < 0.01). Transfemoral access was associated with a greater incidence of vascular complications (OR, 2.1; 95% CI, 1.48-2.99; P < 0.01) but a lower rate of surgical conversion (OR, 0.59; 95% CI, 0.42-0.81; P < 0.01) and similar bleeding (OR, 1.01; 95% CI, 0.81-1.27; P = 0.91) compared with non-transfemoral access. The incidence of cerebrovascular events was similar in both groups (1.6% vs 2.1%; OR, 0.86; 95% CI, 0.64-1.15; P = 0.31).
Transfemoral access was associated with lower rate of 30-day and 1-year mortality compared with non-transfemoral access for TAVI. Randomized studies are needed to ascertain the effect of alternative access sites on clinical outcomes in prohibitive-risk, high-risk, and intermediate-risk populations, using currently available technologies.
经导管主动脉瓣植入术（TAVI）是治疗高危重度主动脉瓣狭窄患者的确定性疗法。本研究旨在确定非经股动脉入路对TAVI临床结局的影响。
我们在SCOPUS上进行了计算机文献检索，选取了2002年至2014年3月12日期间发表的所有英文研究，这些研究比较了经股动脉入路与非经股动脉入路队列。两名独立评审员评估了这些研究并提取数据进行分析。
2007年至2013年期间，共有28项研究纳入了17020例患者（11079例经股动脉入路，5941例非经股动脉入路）接受TAVI。总体而言，经股动脉入路的30天死亡率为4.7%，非经股动脉入路为8.1%（优势比[OR]，0.56；95%置信区间[CI]，0.49 - 0.64；P < 0.01）。经股动脉入路的1年死亡率为16.4%，非经股动脉入路为24.8%（OR，0.68；95% CI，0.60 - 0.75；P < 0.01）。与非经股动脉入路相比，经股动脉入路血管并发症发生率更高（OR，2.1；95% CI，1.48 - 2.99；P < 0.01），但手术转换率更低（OR，0.59；95% CI，0.42 - 0.81；P < 0.01），出血情况相似（OR，1.01；95% CI，0.81 - 1.27；P = 0.91）。两组脑血管事件发生率相似（1.6%对2.1%；OR，0.86；95% CI，0.64 - 1.15；P = 0.31）。
与TAVI的非经股动脉入路相比，经股动脉入路30天和1年死亡率更低。需要进行随机研究，以确定使用现有技术时，替代入路部位对极高危、高危和中危人群临床结局的影响。
