Network Meta-Analysis Comparing the Short- and Long-Term Outcomes of Alternative Access for Transcatheter Aortic...

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Device Technology

Background:

• Limited pooled data exists on comparative efficacy and safety of various transcatheter aortic valve replacement (TAVR) access sites.
• Previous studies primarily focused on pairwise comparisons, necessitating a comprehensive analysis of multiple access routes.

Purpose of the Study:

• To compare short- and long-term outcomes of different alternative access routes for TAVR.
• To provide a pooled estimate of the overall comparative efficacy and safety of various TAVR access strategies.

Main Methods:

• A systematic literature search of PubMed and Cochrane library databases was conducted.
• Thirty-four studies comprising 32,756 patients undergoing TAVR via Transfemoral (TF), Transaortic (TAO), Transapical (TA), Transcarotid (TC), Transaxillary/Subclavian (TSA), or Transcaval (TCV) access were included.
• A frequentist network meta-analysis using a random-effects model with TF access as the reference was performed.

Main Results:

• Transaortic (TAO) and Transapical (TA) access were associated with increased 30-day mortality compared to Transfemoral (TF) access.
• Major vascular complications were lower with Transapical (TA) and Transcarotid (TC) access versus TF.
• One-year mortality was higher with TAO and TA access compared to TF access.

Conclusions:

• Non-thoracic alternative access sites (TC, TSA, TCV) demonstrate outcomes comparable to conventional TF access for TAVR.
• Thoracic TAVR access routes (TAO, TA) are linked to elevated short- and long-term mortality risks.