Meta-Analysis
Copyright ©The Author(s) 2020.
World J Cardiol. Nov 26, 2020; 12(11): 571-583
Published online Nov 26, 2020. doi: 10.4330/wjc.v12.i11.571
Table 1 Characteristics and procedure details of included studies

Junquera et al[2]
Fernandez-Lopez et al[6]
Jackson et al[5]
Allende et al[4]
Curran et al[3]
Study details
Year of publication20202018201820142014
Country of originMultinational (Canada, Europe)FranceThe United KingdomCanadaItaly
Number of centersMulticenterSingle centerSingle centerSingle centerSingle center
Study designRetrospective and prospective cohort studyRetrospective and prospective cohort studyRetrospective cohort studyRetrospective cohort studyRetrospective cohort study
Study subjectsA total of 4949 patients who underwent TAVI between 2007 and 2018 in 10 tertiary centers were included. Selection of secondary access was up to the heart team. 3906 subjects had matched outcomesRetrospective cohort of 194 patients underwent TFSA TAVI between Sept 2015 and Apr 2016. Prospective cohort of 217 pts underwent TRSA TAVI between April 2016 and May 2017All consecutive TAVI cases between May 2015 and June 2017 included. Default TRSA used for all non-TF TAVIs from Jan 2016. Prior to this, secondary access was selected based on clinical groundsConsecutive patients who underwent TAVI from 2007 to 2014 enrolled. From May 2007-Jan 2013, TFSA was chosen. From Jan 2013 onwards, TRSA was chosen in TFPA TAVI and some non-TFPA TAVIA total of 87 consecutive patients who underwent TFPA TAVI between June 2011 and March 2012 were included in the study. The first 46 TRSA candidates and 41 TFSA candidates were considered
Primary accessTF + non-TFTF onlyTF + non-TFTF + non-TFTF only
Total No. of study subjects (APA) with matched or adjusted data if available3906 (TRSA = 928, TFSA = 2978)411 (TRSA = 217, TFSA = 194)199 (TRSA = 135, TFSA = 64)462 (TRSA = 127, TFSA = 335) 87 (TRSA = 46, TFSA = 41)
Total No. of study subjects (TFPA) with matched or adjusted dataNA411 (TRSA = 217, TFSA = 194)179 (TRSA = 115, TFSA = 64)221 (TRSA = 118, TFSA = 103) 87 (TRSA = 46, TFSA = 41)
Definition of bleeding and vascular eventsVARC-2 criteriaVARC-2 criteriaVARC-2 criteriaVARC-2 criteriaOriginal VARC criteria
Limitations of studyNonrandomized study(1) Non-randomized study; (2) Relatively small sample size; (3) TFSA technique was novel resulting in a learning curve(1) Non-randomized study; (2) Relatively small sample size; (3) Unclear if there was a difference in the populations (risk adjustment not reported)(1) Non-randomized study; (2) Relatively small sample size; (3) Low use of percutaneous closure devices (13%) for obtaining hemostasis in TFSA(1) Non-randomized study; (2) Relatively small sample size; (3) TFSA technique was novel resulting in a learning curve
Was risk-adjustment done? Both unadjusted and propensity score-matched data availableAdjusted for age, Euroscore, BMI, NYHA class, type, and size of valve Not reportedAdjusted for gender and peripheral diseaseNot reported
TAVI Procedure details
Hemostasis of PATFPA—Percutaneous in 76.3%, surgical cutdown in 23.7%TFPA—ProGlide deviceTFPA—2 ProGlide devicesTFPA—surgical cutdown NA
Hemostasis of TF secondary accessManual compression (24%), ProGlide (39%), Angio-Seal (37%)Angio-Seal or ProGlideNAManual compression (87%), ProGlide (8%), Angio-Seal (5%)NA
Post-closure angiography?No angiography was performed systematically in TFPA
Table 2 Demographic comparison based on secondary access of matched/adjusted data (if available)
Junquera et al[2]
Fernandez-Lopez et al[6]
Jackson et al[5]
Allende et al[4]
Curran et al[3]

TFSA (n = 2978)
TRSA (n = 928)
TFSA (n = 194)
TRSA (n = 217)
TFSA (n = 64)
TRSA (n = 135)
TFSA (n = 335)
TRSA (n = 127)
TFSA (n = 41)
TRSA (n = 46)
Baseline characteristics of patients
Age81 ± 481 ± 883 ± 782 ± 682 ± 682 ± 779 ± 880 ± 980 ± 1080 ± 5
%Male52.60%53.20%44.80%53.50%57.00%43.00%45.00%61.00%31.70%52.20%
Baseline comorbidities
Diabetes26.90%27.00%31.40%24.40%20.00%20.00%35.00%31.00%30.00%26.10%
HTN--56.70%55.30%--88.00%84.00%92.50%80.40%
CAD51.20%50.30%--53.00%52.60%67.00%63.00%--
Previous CABG19.80%19.60%4.10%6.00%20.00%19.30%39.00%33.00%17.10%17.40%
AFib33.50%34.70%27.80%33.60%25.00%25.00%17.00%20.00%--
PVD16.30%19.20%13.40%14.30%18.00%26.70%40.00%24.00%--
Prior CVA--10.30%10.60%17.00%16.30%19.00%16.00%--
eGFR < 60 mL/min/1.73 m267.60%69.40%----57.00%51.00%--
COPD/Pul disease21.30%20.90%11.90%13.40%25.00%25.90%29.00%25.00%20.00%13.00%
STS-PROM score4.54.75.0 ± 3.04.8 ± 3.6--7.1 ± 4.57.2 ± 5.09.0 ± 7.8 7.2 ± 7.5
Valve type
Balloon-expandable60.00%63.50%NANANANA96.00%88.00%NANA
Self-expandable40.00%36.50%NANANANA3.00%10.00%NANA
1° Access
TFPA88.50%89.90%100%100%100%85.20%30.80%93.00%100%100%
Non-TFPA11.50%10.10%00014.80%69.20%7.00%00
Transapical 9.10%3.70%58.20%6.00%
Transaortic 1.90%8.80%10.70%1.00%
Subclavian 1.50%2.20%0.30%0
Transcarotid 4.06%000
Transcaval 0.12%000