Related Experiment Video
Updated: Jan 13, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Comparative Effectiveness of Balloon Aortic Valvuloplasty via Transradial and Transfemoral Access
Jonathan X Fang1,2, Pedro A Villablanca1, Tiberio M Frisoli1
1Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan.
Background:
Balloon aortic valvuloplasty (BAV) is commonly performed as a bridge to therapy, for stratification, or as a palliative procedure in cases of severe aortic stenosis. The complication rate of transfemoral access BAV (transfemoral valvuloplasty [TFV]) is comparable to that of transcatheter aortic valve replacement. Transradial access BAV (transradial valvuloplasty [TRV]) is technically feasible; however, comparative data for TFV are lacking. We aim to compare TFV and TRV in terms of technical and hemodynamic success, periprocedural safety, and short-term clinical outcomes.
Methods:
Consecutive patients undergoing BAV at a tertiary center from 2021 to 2024 were assessed. TRV was performed with ultrasound guidance and an 8F short sheath equipped with compatible balloons. Hemodynamic success was defined as a reduction in gradient of 30% or more. The primary outcome was the periprocedural composite of a Valve Academic Research Consortium (VARC) 3 major vascular complication, grade 3 to 4 bleeding, and balloon entrapment, and nonaccess-related events, including complete heart block, periprocedural stroke, hypotension, severe aortic insufficiency, and periprocedural death. The secondary outcome was the 30-day composite of all-cause mortality, cardiac-related hospitalization, and discharge failure. Inverse probability of treatment weighting, followed by multivariate regression, was employed to address confounders.
Results:
105 TRV and 148 TFV were included. Technical success rate was 96.2% for TRV and 98.7% for TFV (P = .21). The primary outcome event rate was significantly lower in the TRV compared to the TFV group: 2.53% vs 17.47%; adjusted odds ratio, 0.13; 95% CI, 0.04-0.49; P = .003. Technical and hemodynamic success and secondary outcomes were comparable between TRV and TFV.
Conclusions:
In comparison to TFV, TRV is associated with lower rates of periprocedural safety events while maintaining similar short-term clinical outcomes and hemodynamic performance.
