Objective To systemically evaluate the occurrence of common peri-operative complications in transcatheter aortic valve implantation (TAVI) through different approaches. Methods We searched the database, including PubMed, Embase, Ovid Medline and Database of Abstracts of Review of Effectiveness (DARE) and selected the published randomized controlled studies on the TAVI through the transapical (TAp group) or transfemoral (TF group) or transaortic (TAo group) approaches. And we compared and analyzed the 30-day post-operative mortality and the incidences of early paravalvular leakage (PVL), severe hemorrhage, major vascular complications, stroke, acute kidney injury (AKI) and permanent pacemaker (PPM) required atrioventricular block (AVB). A meta-analysis was carried out by Review Manager 5.3 software. Results A total of 22 studies, 11 530 cases were included in this study. Compared with the TF group, the incidence of early PVL in the TAp and TAo groups was significantly lower (4.6%[63/1 384] vs 9.2%[400/4 366], P<0.000 01; 6.4%[33/518] vs 9.3%[331/3 541], P=0.002), while the 30-day post-operative mortality was significantly higher (10.0%[271/2 711] vs 4.8%[326/6 756], P<0.000 01; 8.9%[46/518] vs 4.5%[160/3 541], P=0.002). The incidence of severe hemorrhage in the TAp and TAo groups was significantly higher than that in the TF group (8.4%[186/2 204] vs 3.9%[268/6 818], P<0.000 01; 6.5%[35/542] vs 1.4%[50/3 569], P=0.01). The major vascular complication had a lower incidence in the TAp group compared with the TF group (2.3%[58/2 524] vs 6.5%[417/6 367], P<0.000 01). There was no difference in the occurrence of stroke among the three groups (P>0.05). TF group showed a significant reduction of AKI incidence compared with the TAp group (8.3%[610/7 334] vs 22.8%[615/2 699], P<0.000 01) and the TAo group (3.1%[110/3 569] vs 12.5%[68/542], P<0.000 01). TF group showed a significant increase in the incidence of PPM required AVB compared with the TAo group (13.2%[472/3 569] vs 9.2%[50/542], P=0.003). Conclusion The TAp and TF approaches have a shorter path in TAVI and can significantly reduce the occurance of PVL and major vascular impairment, which is an unique advantage and has potential value.