A meta-analysis comparing transaxillary and transfemoral transcatheter aortic valve replacement

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Transfemoral (TF) access is standard for transcatheter aortic valve replacement (TAVR).
• Transaxillary (TAx) access is an emerging alternative, but its comparative efficacy requires further elucidation.
• This meta-analysis focuses on the CoreValve device to minimize device-specific bias.

Purpose of the Study:

• To compare the outcomes of TAx-TAVR versus TF-TAVR.
• To evaluate procedural and clinical outcomes between the two access routes.
• To assess safety and efficacy in high-risk patient cohorts.

Main Methods:

• A systematic literature search was conducted in PubMed/MEDLINE, EMBASE, and the Cochrane Library up to December 2018.
• Included studies specifically utilized the CoreValve self-expandable device for TAx-TAVR and TF-TAVR.
• Data on baseline characteristics, procedural success, and clinical outcomes were extracted and analyzed.

Main Results:

• The meta-analysis included five studies with 1,414 patients in the TF group and 489 in the TAx group.
• No significant differences were observed in vascular complications, aortic regurgitation, or permanent pacemaker implantation rates.
• The TAx group showed a lower incidence of acute kidney injury (AKI) but similar 30-day and 1-year mortality rates compared to the TF group.

Conclusions:

• Transaxillary TAVR demonstrates comparable clinical outcomes to transfemoral TAVR in high-risk patients.
• Despite a higher comorbidity burden in the TAx group, this approach appears to be associated with a reduced risk of AKI.
• TAx-TAVR is a viable alternative access route for selected patients undergoing aortic valve replacement.