Two alternative approaches for transcatheter aortic valve implantation (TAVI) exist for patients unsuitable for the transfemoral approach; the transapical and the transaortic approaches. It is unclear as to which approach has superior short-term outcomes. A systematic review and meta-analysis was performed to answer this question. Mortality was equivalent in the 2 groups. There was a trend toward a lower rate of stroke in the transaortic group (0.9% vs 2.1%) but this was not statistically significant. Conversion to surgical aortic valve replacement, paravalvular leak, pacemaker requirement, and major bleeding occurred at equivalent rates.