A Meta-analysis of percutaneous access <b><i>versus</i></b> surgical cutdown in transfemoral transcatheter aortic valve implantation _West China Medical Journal

Authors：

WANG Xi , LI Yiming , LIAO Yanbiao , LI Yijian , XU Yuanning , FENG Yuan ,  CHEN Mao

Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CHEN Mao, Email: hmaochen@vip.sina.com

Keywords：

Transcatheter aortic valve implantation; Femoral artery surgical cutdown; Percutaneous access; Meta-analysis

DOI：

10.7507/1002-0179.201711134

Video：

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ObjectiveTo systematically assess the efficacy and safety of percutaneous access and surgical cutdown in transfemoral transcatheter aortic valve implantation (TF-TAVI).MethodsWe searched databases including the Cochrane Library, PubMed, OVID, Embase, China National Knowledge Internet and Wanfang Database to collect randomized or non-randomized controlled trials comparing percutaneous access (PC group, the trial/exposure group) with surgical cutdown (SC group, the control group) in TF-TAVI between January 2002 and October 2017. The quality evaluation and data extraction were carried out by 2 reviewers independently. The Meta-analysis was performed using RevMan 5.3.5 software.ResultsA total of 11 literatures involving 4 893 aortic valve stenosis patients treated by TF-TAVI (2 877 patients in PC group and 2 016 patients in SC group) were included in this Meta-analysis. There was no significant difference between PC and SC group in terms of major vascular complications [odds ratio (OR)=0.86, 95% confidence interval (CI) (0.70, 1.06), P=0.17], minor vascular complications [OR=1.43, 95%CI (0.87, 2.37), P=0.16], major bleeding [OR=1.02, 95%CI (0.55, 1.90), P=0.94], minor bleeding [OR=0.90, 95%CI (0.51, 1.61), P=0.73] and all-cause mortality within 30 days [OR=1.03, 95%CI (0.76, 1.40), P=0.85]. As for the length of stay after TAVI, there was significant difference between the two groups [standard mean difference=–0.32, 95%CI (–0.52, –0.12), P=0.002].ConclusionPercutaneous access is as effective and safe as surgical cutdown in TF-TAVI, meanwhile leading to shorter length of stay after TAVI.

Citation： WANG Xi, LI Yiming, LIAO Yanbiao, LI Yijian, XU Yuanning, FENG Yuan, CHEN Mao. A Meta-analysis of percutaneous access versus surgical cutdown in transfemoral transcatheter aortic valve implantation . West China Medical Journal, 2018, 33(2): 210-217. doi: 10.7507/1002-0179.201711134 Copy

1.	Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med, 2010, 363(17): 1597-1607.
2.	Adamo M, Fiorina C, Curello S, et al. Role of different vascular approaches on transcatheter aortic valve implantation outcome: a single-center study. J Cardiovasc Med (Hagerstown), 2015, 16(4, SI): 279-285.
3.	Kappetein AP, Head SJ, Généreux P, et al. Valve Academic Research Consortium (VARC)-2. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (VARC-2). Eur J Cardiothorac Surg, 2012, 42(5): S45-S60.
4.	Toggweiler S, Leipsic J, Binder RK, et al. Management of vascular access in transcatheter aortic valve replacement part 2: vascular complications. JACC Cardiovasc Interv, 2013, 6(8): 767-776.
5.	Kawashima H, Watanabe Y, Kozuma K, et al. Propensity-matched comparison of percutaneous and surgical cut-down approaches in transfemoral transcatheter aortic valve implantation using a balloon-expandable valve. EuroIntervention, 2017, 12(16): 1954-1961.
6.	Ando T, Briasoulis A, Holmes AA, et al. Percutaneous versus surgical cut-down access in transfemoral transcatheter aortic valve replacement: a meta-analysis. J Card Surg, 2016, 31(12): 710-717.
7.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0[updated March 2011] . The Cochrane Collaboration, 2011. http://handbook.cochrane.org.
8.	Bernardi FL, Gomes WF, de Brito FS Jr, et al. Surgical cutdown versus percutaneous access in transfemoral transcatheter aortic valve implantation: insights from the Brazilian TAVI registry. Catheter Cardiovasc Interv, 2015, 86(3): 501-505.
9.	Drafts BC, Choi CH, Sangal K, et al. Comparison of outcomes with surgical cut-down versus percutaneous transfemoral transcatheter aortic valve replacement: TAVR transfemoral access comparisons between surgical cut-down and percutaneous approach. Catheter Cardiovasc Interv, 2017. doi: 10.1002/ccd.27377.
10.	Hernández-Enriquez M, Andrea R, Brugaletta S, et al. Puncture versus surgical cutdown complications of transfemoral aortic valve implantation (from the Spanish TAVI Registry). Am J cardiol, 2016, 118(4): 578-584.
11.	Holper EM, Kim RJ, Mack M, et al. Randomized trial of surgical cutdown versus percutaneous access in transfemoral TAVR. Catheter Cardiovasc Interv, 2014, 83(3): 457-464.
12.	Kadakia MB, Herrmann HC, Desai ND, et al. Factors associated with vascular complications in patients undergoing balloon-expandable transfemoral transcatheter aortic valve replacement via open versus percutaneous approaches. Circ Cardiovasc Interv, 2014, 7(4): 570-576.
13.	McCabe JM, Huang PH, Cohen DJ, et al. Surgical versus percutaneous femoral access for delivery of large-bore cardiovascular devices (from the PARTNER trial). Am J cardiol, 2016, 117(10): 1643-1650.
14.	Nakamura M, Chakravarty T, Jilaihawi H, et al. Complete percutaneous approach for arterial access in transfemoral transcatheter aortic valve replacement: a comparison with surgical cut-down and closure. Catheter Cardiovasc Interv, 2014, 84(2): 293-300.
15.	Spitzer SG, Wilbring M, Alexiou KA, et al. Surgical cut-down or percutaneous accesswhich is best for less vascular access complications in transfemoral TAVI?. Catheter Cardiovasc Interv, 2016, 88(2): E52-E58.
16.	Van Mieghem NM, Tchetche D, Chieffo AA, et al. Incidence, predictors, and implications of access site complications with transfemoral transcatheter aortic valve implantation. Am J Cardiol, 2012, 110(9): 1361-1367.
17.	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol, 2017, 70(2): 252-289.
18.	Frohlich GM, Baxter PD, Malkin CJ, et al. Comparative survival after transapical, direct aortic, and subclavian transcatheter aortic valve implantation (data from the UK TAVI registry). Am J Cardiol, 2015, 116(10): 1555-1559.
19.	Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in Intermediate-Risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
20.	Manunga JM, Gloviczki P, Oderich GS, et al. Femoral artery calcification as a determinant of success for percutaneous access for endovascular abdominal aortic aneurysm repair. J Vasc Surg, 2013, 58(5): 1208-1212.
21.	Ott I, Shivaraju A, Schaffer NR, et al. Parallel suture technique with ProGlide: a novel method for management of vascular access during transcatheter aortic valve implantation (TAVI). EuroIntervention, 2017, 13(8): 928-934.
22.	Elbaz-Greener G, Zivkovic N, Arbel YA, et al. Use of two-dimensional ultrasonographically guided access to reduce access-related complications for transcatheter aortic valve replacement. Can J Cardiol, 2017, 33(7): 918-924.

1. Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med, 2010, 363(17): 1597-1607.
2. Adamo M, Fiorina C, Curello S, et al. Role of different vascular approaches on transcatheter aortic valve implantation outcome: a single-center study. J Cardiovasc Med (Hagerstown), 2015, 16(4, SI): 279-285.
3. Kappetein AP, Head SJ, Généreux P, et al. Valve Academic Research Consortium (VARC)-2. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (VARC-2). Eur J Cardiothorac Surg, 2012, 42(5): S45-S60.
4. Toggweiler S, Leipsic J, Binder RK, et al. Management of vascular access in transcatheter aortic valve replacement part 2: vascular complications. JACC Cardiovasc Interv, 2013, 6(8): 767-776.
5. Kawashima H, Watanabe Y, Kozuma K, et al. Propensity-matched comparison of percutaneous and surgical cut-down approaches in transfemoral transcatheter aortic valve implantation using a balloon-expandable valve. EuroIntervention, 2017, 12(16): 1954-1961.
6. Ando T, Briasoulis A, Holmes AA, et al. Percutaneous versus surgical cut-down access in transfemoral transcatheter aortic valve replacement: a meta-analysis. J Card Surg, 2016, 31(12): 710-717.
7. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0[updated March 2011] . The Cochrane Collaboration, 2011. http://handbook.cochrane.org.
8. Bernardi FL, Gomes WF, de Brito FS Jr, et al. Surgical cutdown versus percutaneous access in transfemoral transcatheter aortic valve implantation: insights from the Brazilian TAVI registry. Catheter Cardiovasc Interv, 2015, 86(3): 501-505.
9. Drafts BC, Choi CH, Sangal K, et al. Comparison of outcomes with surgical cut-down versus percutaneous transfemoral transcatheter aortic valve replacement: TAVR transfemoral access comparisons between surgical cut-down and percutaneous approach. Catheter Cardiovasc Interv, 2017. doi: 10.1002/ccd.27377.
10. Hernández-Enriquez M, Andrea R, Brugaletta S, et al. Puncture versus surgical cutdown complications of transfemoral aortic valve implantation (from the Spanish TAVI Registry). Am J cardiol, 2016, 118(4): 578-584.
11. Holper EM, Kim RJ, Mack M, et al. Randomized trial of surgical cutdown versus percutaneous access in transfemoral TAVR. Catheter Cardiovasc Interv, 2014, 83(3): 457-464.
12. Kadakia MB, Herrmann HC, Desai ND, et al. Factors associated with vascular complications in patients undergoing balloon-expandable transfemoral transcatheter aortic valve replacement via open versus percutaneous approaches. Circ Cardiovasc Interv, 2014, 7(4): 570-576.
13. McCabe JM, Huang PH, Cohen DJ, et al. Surgical versus percutaneous femoral access for delivery of large-bore cardiovascular devices (from the PARTNER trial). Am J cardiol, 2016, 117(10): 1643-1650.
14. Nakamura M, Chakravarty T, Jilaihawi H, et al. Complete percutaneous approach for arterial access in transfemoral transcatheter aortic valve replacement: a comparison with surgical cut-down and closure. Catheter Cardiovasc Interv, 2014, 84(2): 293-300.
15. Spitzer SG, Wilbring M, Alexiou KA, et al. Surgical cut-down or percutaneous accesswhich is best for less vascular access complications in transfemoral TAVI?. Catheter Cardiovasc Interv, 2016, 88(2): E52-E58.
16. Van Mieghem NM, Tchetche D, Chieffo AA, et al. Incidence, predictors, and implications of access site complications with transfemoral transcatheter aortic valve implantation. Am J Cardiol, 2012, 110(9): 1361-1367.
17. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol, 2017, 70(2): 252-289.
18. Frohlich GM, Baxter PD, Malkin CJ, et al. Comparative survival after transapical, direct aortic, and subclavian transcatheter aortic valve implantation (data from the UK TAVI registry). Am J Cardiol, 2015, 116(10): 1555-1559.
19. Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in Intermediate-Risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
20. Manunga JM, Gloviczki P, Oderich GS, et al. Femoral artery calcification as a determinant of success for percutaneous access for endovascular abdominal aortic aneurysm repair. J Vasc Surg, 2013, 58(5): 1208-1212.
21. Ott I, Shivaraju A, Schaffer NR, et al. Parallel suture technique with ProGlide: a novel method for management of vascular access during transcatheter aortic valve implantation (TAVI). EuroIntervention, 2017, 13(8): 928-934.
22. Elbaz-Greener G, Zivkovic N, Arbel YA, et al. Use of two-dimensional ultrasonographically guided access to reduce access-related complications for transcatheter aortic valve replacement. Can J Cardiol, 2017, 33(7): 918-924.

West China Medical Journal

A Meta-analysis of percutaneous access versus surgical cutdown in transfemoral transcatheter aortic valve implantation

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