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Related Experiment Video

Updated: Sep 24, 2025

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
06:02

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation

Published on: August 8, 2025

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Transcaval Versus Transaxillary TAVR in Contemporary Practice: A Propensity-Weighted Analysis.

Robert J Lederman1, Vasilis C Babaliaros2, John C Lisko2

  • 1Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.

JACC. Cardiovascular Interventions
|May 5, 2022
PubMed
Summary

Transcaval access for transcatheter aortic valve replacement (TAVR) showed significantly lower stroke rates compared to transaxillary access. This study suggests transcaval TAVR may be a favorable alternative for select patients.

Keywords:
alternative accessnonfemoral accesspercutaneous accesssubclavian accesstransaxillary accesstranscaval access

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Surgical Outcomes

Background:

  • Transcatheter aortic valve replacement (TAVR) is a crucial procedure for aortic stenosis.
  • Systematic comparisons between transcaval and transaxillary TAVR access routes are lacking.
  • Non-femoral access is increasingly utilized for TAVR in specific patient populations.

Purpose of the Study:

  • To compare the safety and efficacy of transcaval versus transaxillary artery access for TAVR.
  • To evaluate outcomes associated with these non-femoral access routes in contemporary practice.
  • To provide data-driven insights for procedural decision-making in TAVR.

Main Methods:

  • Retrospective analysis of data from 8 experienced US centers (2017-2020) within the STS/ACC TVT Registry.
  • Comparison of outcomes between transcaval (n=238) and transaxillary (n=106) access, with transfemoral (n=7,132) as a reference.
  • Doubly robust estimation (inverse propensity weighting plus regression) used to adjust for baseline differences.

Main Results:

  • Transcaval access had a 5-fold lower rate of stroke/transient ischemic attack (2.5% vs 13.2%) compared to transaxillary access.
  • Major bleeding and blood transfusion rates were similar between transcaval and transaxillary access.
  • Higher rates of discharge directly home without stroke/TIA were observed with transcaval access (87.8% vs 62.3%).

Conclusions:

  • Transcaval TAVR access is associated with significantly lower stroke rates and comparable bleeding to transaxillary access.
  • Both non-femoral approaches demonstrated higher complication rates than transfemoral access.
  • Transcaval TAVR access presents a potentially attractive alternative for suitable patients.