Vascular access for transcatheter aortic valve replacement: A network meta-analysis

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Surgical Outcomes Research

Background:

• Transcatheter aortic valve replacement (TAVR) offers a less invasive option for aortic stenosis.
• Choosing an alternative access route for TAVR is critical when transfemoral (TF) access is not feasible.
• Peripheral vascular access options include trans-subclavian (Tsc), transcarotid (TC), and transcaval (Tcav) approaches.

Purpose of the Study:

• To compare the safety and efficacy of different peripheral vascular access routes for TAVR.
• To evaluate outcomes associated with Tsc, TC, and Tcav access compared to TF access.
• To provide evidence-based guidance for selecting TAVR access in challenging cases.

Main Methods:

• A comprehensive network meta-analysis was performed.
• Searched MEDLINE and EMBASE databases through July 2022 for relevant studies.
• Included 33 observational studies with 43,455 patients undergoing TAVR via TF, Tsc, TC, or Tcav access.

Main Results:

• Trans-subclavian (Tsc) access was associated with increased risk of major or life-threatening bleeding compared to transfemoral (TF) access (OR 1.51).
• Stroke risk was significantly higher with Tsc access versus TF and transcaval (Tcav) access (OR 2.00 and 2.43, respectively).
• Transcaval (Tcav) access demonstrated the highest rate of major vascular complications, while transcarotid (TC) access showed lower risks compared to Tsc and Tcav.

Conclusions:

• Trans-subclavian (Tsc) access for TAVR is linked to higher rates of stroke and bleeding compared to transfemoral (TF) access.
• Transcaval (Tcav) access is associated with the greatest risk of major vascular complications among the evaluated TAVR access routes.
• The findings highlight the importance of careful consideration of access route risks in TAVR procedures.