Table 1

Characteristics of the included studies

StudyCountryStudy designIntervention (N)Type of valveDuration of follow-up
(days or months)
OutcomesMain finding
Paparella 201917ItalyRetrospective cohortmiAVR (386)Mechanical (Bicarbon and CarboMedics); Biological (Hancock II and Mosaic)*30-day ACM, stroke, repeat intervention, AF, AKI, hospitalisation duration
  • The miAVR arm required more blood transfusion, longer hospitalisation,and had a higher incidence of AKI.

  • The TAVI arm had more permanent pacemakers.

  • No differences in terms of 30-day mortality or stroke.

TAVI (386)(98% TF; 2% TA)†CoreValve (93.2%), Lotus (6.8%)†
Furukawa 201818GermanyRetrospective cohortmiAVR (177)miAVR: Perimount Magna (74%), Perimount Magna Ease (14.1%), Hancock II (2.8%), Trifecta (7.9%), Perceval (1.1%)766 days30-day ACM, bleeding, stroke, AMI, AF, AKI, paravalvular leakage, hospitalisation duration
  • Longer hospitalisation in the transapical arm.

  • The transapical arm trended towards worse midterm survival.

  • No differences in terms of 30-day mortality, stroke or myocardial infarction.

TA–TAVI (177)TA–TAVI: Sapien XT (41.8%), Sapien 3 (32.2%), Accurate TA (26%)
TF–TAVI (177)CoreValve (55.9%), Sapien XT 15.8%, Sapien 3 (14.7%), Accurate TF neo (2.3%), Direct Flow (11.3%)
Calle-Valda 201719SpainRetrospective cohortmiAVR (50)NA46.7 months30-day ACM, repeat intervention (re-exploration for bleeding), bleeding (postoperative bleeding mL/24 hours), stroke (30 days), AF, 30-day readmission, hospitalisation duration (days)The TAVI arm required more pacemakers and had higher rates of paravalvular leakage.
The TAVI arm required shorter hospitalisation.
TF–TAVI (50)CoreValve (100%)No statistically significant differences in terms of survival.
Bruno 201722ItalyRetrospective cohortmiAVR (19)Intuity Valve (100%)29.1 months
27.7 months
ACM, bleeding, stroke, AMI, AF, paravalvular leakage (early and midterm), hospitalisation duration
  • The TAVI arm required more pacemakers and had higher rates of paravalvular leakage.

  • No significant differences in terms of mortality.

TF–TAVI (30)CoreValve (100%)
Hijri 201730USARetrospective cohortSAVR (722)Bioprosthetic (92%), Mechanical (8%)35 monthsOperative mortality, AKI, hospitalisation durationThe TAVI (irrespective of approach), miAVR and conventional surgical arms had comparable rates of intraoperative and midterm mortality.
TAVI (306)Sapien (28.4%), Sapien XT (23.9%), Sapien 3 (30.7%), CoreValve (15%)
Nguyen 20179USARetrospective cohortmiAVR (699)NA30 day ACM, stroke, AF, dialysis, hospitalisation duration
  •  The results showed an increasing rate of adoption for TF–TAVI and miAVR, but a decrease in TA–TAVI and conventional surgery.

  •  30-day mortality was highest for TA–TAVR, followed by TF–TAVR, SAVR and miAVR.

Tokarek 2015/201623PolandRetrospective cohortTF–TAVI (39)Sapien XT (79%), CoreValve (21%)583.5 daysACM (30 days, 6 months, 1 year), bleeding, stroke, AMI, AF, paravalvular leakage QoL (EQ-5D-3L and MLHFQ 24 M)
  • The TAVI arm had a higher ejection fraction, but there were no differences in mortality (2015).

  • The TAVI arm had better QoL for up to 1 year, but no differences persisted at 2 years (2016).

MT (50)NA
MS (44)NA
Miceli 201621ItalyRetrospective cohortRT (37)Perceval S (100%)13 monthsMortality, bleeding, stroke, paravalvular leakage, AKI, hospitalisation duration
  •  The TAVI arm had a significantly higher rate of paravalvular leakage.

  •  No significant differences in terms of stroke, 1 year and 2 year survival.

TAVI (37)(51.6% TF; 48.3% TA)**Sapien (100%)
Santarpino 201416GermanyRetrospective cohortMIS (37)Perceval (100%)18.9 monthsIn-hospital mortality, stroke, paravalvular leakage, AKI
  • In high-risk patients, cumulative survival was higher in the miAVR arm compared with the TAVI arm.

  • TAVI had significantly higher rates of paravalvular leakage, which was significantly associated with mortality.

TAVI (37) (59% TA; 40.2% TF; 0.8% transaortic)†Sapien, Sapien XT*
Haldenwang 201429GermanyRetrospective cohortmiAVR (77)Perimount, Trifecta* AKI
  • TA–TAVI carried a higher risk of AKI.

TA–TAVI (56)SAPIEN (100%)
Zierer 200920GermanyRetrospective cohortTA–TAVI (21)Cribier-Edwards (100%)ACM (30 days, 1 year), repeat intervention, stroke, AMI, AF, hospitalisation duration
  • TA–TAVI had shorter postoperative recovery.

  • There were no significant differences in terms of morbidity or mortality.

PUS-AVR (30)Perimount (100%)
  • *Insufficient data provided to specify the percentages used for each valve type.

  • †Percentages given for overall cohort rather than the propensity-matched cohort used for analysis, as data for the latter were not available.

  • ACM, all-cause mortality; AF, atrial fibrillation; AKI, acute kidney injury; ; AMI, acute myocardial infarction; miAVR, minimally invasive aortic valve replacement; MIS, minimally invasive sutureless; MS, ministernotomy; MT, mini-thoracotomy; NA, not available; PUS-AVR, partial upper sternotomy-aortic valve replacement; RD-AVR, rapid-deployment aortic valve replacement; RT, right anterior mini-thoracotomy; SAVR, surgical aortic valve replacement; TA, transapical; TAVI, transcatheter aortic valve implantation; TAVR, transcatheter aortic valve replacement; TF, transfemoral.