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Abusnina W, Machanahalli Balakrishna A, Ismayl M, Latif A, Reda Mostafa M, Al-abdouh A, Junaid Ahsan M, Radaideh Q, Haddad TM, Goldsweig AM, Ben-Dor I, Mamas MA, Dahal K. Comparison of Transfemoral versus Transsubclavian/Transaxillary access for transcatheter aortic valve replacement: A systematic review and meta-analysis. IJC Heart & Vasculature 2022; 43:101156. [PMCID: PMC9718962 DOI: 10.1016/j.ijcha.2022.101156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
Femoral access is the gold standard for transcatheter aortic valve replacement (TAVR). Safe alternative access, that represents about 15 % of TAVR cases, remains important for patients without adequate transfemoral access. We aimed to perform a systematic review and meta-analysis of studies comparing transfemoral (TF) access versus transsubclavian or transaxillary (TSc/TAx) access in patients undergoing TAVR. We searched PubMed, Cochrane CENTRAL Register, EMBASE, Web of Science, Google Scholar and ClinicalTrials.gov (inception through May 24, 2022) for studies comparing (TF) to (TSc/TAx) access for TAVR. A total of 21 studies with 75,995 unique patients who underwent TAVR (73,203 transfemoral and 2,792 TSc/TAx) were included in the analysis. There was no difference in the risk of in-hospital and 30-day all-cause mortality between the two groups (RR 0.64, 95 % CI 0.36–1.13, P = 0.12) and (RR 0.95, 95 % CI 0.64–1.41, P = 0.81), while 1-year mortality was significantly lower in the TF TAVR group (RR 0.79, 95 % CI 0.67–0.93, P = 0.005). No significant differences in major bleeding (RR 0.82, 95 % CI 0.65–1.03, P = 0.09), major vascular complications (RR 1.14, 95 % CI 0.75–1.72, P = 0.53), and stroke (RR 0.66, 95 % CI 0.42–1.02, P = 0.06) were observed. In patients undergoing TAVR, TF access is associated with significantly lower 1-year mortality compared to TSc/TAx access without differences in major bleeding, major vascular complications and stroke. While TF is the preferred approach for TAVR, TSc/TAx is a safe alternative approach. Future studies should confirm these findings, preferably in a randomized setting.
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Key Words
- tavr
- tavi
- access site
- subclavian access
- axillary access
- femoral access
- aki, acute kidney injury
- as, aortic stenosis
- ci, confidence interval
- mi, myocardial infarction
- rr, risk ratio
- tavr, transcatheter aortic valve replacement
- tf, transfemoral
- tsc, transsubclavian
- tax, transaxillary
- tc, transcarotid
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Affiliation(s)
- Waiel Abusnina
- Division of Cardiology, Creighton University School of Medicine, NE, USA
| | | | - Mahmoud Ismayl
- Division of Cardiology, Creighton University School of Medicine, NE, USA
| | - Azka Latif
- Division of Cardiology, Creighton University School of Medicine, NE, USA
| | | | - Ahmad Al-abdouh
- Department of Medicine, University of Kentucky, Lexington, KY, USA
| | | | - Qais Radaideh
- Division of Cardiology, Creighton University School of Medicine, NE, USA
| | - Toufik M. Haddad
- Division of Cardiology, Creighton University School of Medicine, NE, USA
| | - Andrew M. Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, USA
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, UK
| | - Khagendra Dahal
- Division of Cardiology, Creighton University School of Medicine, NE, USA,Corresponding author
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