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

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.