Transcaval access for transcatheter aortic valve replacement: a systematic review and meta-analysis

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Devices

Background:

• Transfemoral access is the standard for transcatheter aortic valve replacement (TAVR).
• Alternative access routes are needed when transfemoral access is contraindicated.
• The safety of the transcaval approach for TAVR is uncertain.

Purpose of the Study:

• To evaluate the safety of the transcaval approach for TAVR.
• To compare the transcaval approach with alternative TAVR access routes.

Main Methods:

• A meta-analysis of studies reporting transcaval access in TAVR patients.
• Searched PubMed, SCOPUS, Web of Science, Cochrane Library, and Embase until April 2024.
• Used Risk Ratio (RR) for dichotomous outcomes and Mean Difference (MD) for continuous outcomes.

Main Results:

• Eleven studies with 1003 patients were included.
• Transcaval access showed no significant difference in intra-hospital, 30-day, or long-term all-cause mortality compared to alternatives.
• Pooled 30-day mortality was 7% (95% CI 5-10) and long-term mortality was 21% (95% CI 2-77).

Conclusions:

• Transcaval access is a safe and feasible TAVR method.
• It can be considered an alternative when transfemoral access is contraindicated.