Key result
Transaxillary TAVI significantly reduced 30-day mortality compared to the transaortic approach (4.2% vs. 9.6%, RR 0.46) in patients with aortic stenosis.
Why the study?
Benefits of one TAVR approach over another were still being evaluated, prompting a comparison of clinical and procedural outcomes between transaxillary and transaortic approaches.
Does transaxillary TAVR improve clinical and procedural outcomes compared to transaortic TAVR in patients with aortic stenosis?
Meta-Analysis (n=1,793)
Yes
Does transaxillary TAVR improve clinical and procedural outcomes compared to transaortic TAVR in patients with aortic stenosis?
Effect estimate: RR 0.46 (95% CI 0.31, 0.69)
Absolute Event Rate: 4.2% vs 9.6%
p-value: p=0.0001
Transaxillary TAVR is associated with lower 30-day mortality and acute kidney injury compared to transaortic TAVR, though it carries a higher risk of vascular complications and pacemaker implantation.
Transaxillary access may lower 30-day mortality versus transaortic; leaves open randomized confirmation amid vascular trade-offs.
Transcatheter aortic valve replacement (TAVR) is a technique that can be performed through multiple approaches, and the benefits of one approach over another are still being evaluated to make sure patients receive the best possible care. Our meta-analysis aims to compare clinical and procedural outcomes of the transaxillary (TAx) and transaortic (TAo) approaches to validate the more optimal procedure. The systematic literature search was done via PubMed/MEDLINE, Embase, and the Cochrane Central databases from inception to December 2021, to identify articles reporting data on both TAx TAVR and TAo TAVR. In addition, we checked ClinicalTrials.gov for more published or unpublished trials. Baseline patient characteristics, procedure results, and clinical results were extracted from the article and pooled for analysis. A quantitative meta-analysis was conducted using Review Manager (RevMan) version 5.3 (Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). The outcomes extracted included blood transfusion, conversion to sternotomy, tamponade, contrast amount, procedure time, bleeding incidents (minor, major, or life-threatening), length of stay (LOS), vascular complications (minor or major), acute kidney injury (AKI), paravalvular leak (PVL), permanent pacemaker (PPM) implantation, 30-day mortality, one-year mortality, 30-day stroke, and device success. The final analysis included 11 articles, consisting of 10 observational studies and a pivotal trial. Cumulative results revealed that the TAo approach had a significantly lower incidence of vascular complications (RR = 2.30; 95% CI = 1.22 to 4.35), and the need for implantation of a permanent pacemaker (RR = 1.82; 95% CI = 1.30 to 2.54) along with a lower amount of contrast (mean difference (MD) = 27.40; 95% CI = 3.73 to 51.08) needed to be used. The TAx group was associated with a significantly lower 30-day mortality (RR = 0.46; 95% CI = 0.31 to 0.69), AKI (RR = 0.47; 95% CI = 0.33 to 0.67), and length of hospital stay (MD = -1.95; 95% CI = -2.51 to -1.38). No significant difference was observed between the outcomes of 30-day stroke (RR = 1.38; 95% CI = 0.81 to 2.33), PVL (RR = 1.05; 95% CI = 0.50 to 2.18), tamponade (RR = 0.71; 95% CI = 0.12 to 4.03), conversion to sternotomy (RR = 0.51; 95% CI = 0.06 to 4.30), device success (RR = 0.97; 95% CI = 0.88 to 1.07), the incidence of bleeding (RR = 0.75; 95% CI = 0.51 to 1.10), and procedure time (MD = 4.44; 95% CI = -96.30 to 105.17). Both the procedures were associated with their benefits and risks. Although most of the outcomes favored TAx transcatheter aortic valve implantation (TAVI), it is too early to say if it would be better than TAo TAVI. To authenticate the findings concluded in this meta-analysis and further improve our understanding of the efficacy, safety, and risk profile between TAx and TAo approaches for TAVI, large sample randomized clinical trials are required on a wide scale.
No takes yet. Share an insight, caveat, or question.
Hameed et al. (2022) conducted a meta-analysis in Aortic Stenosis (n=1,793). Transaxillary (TAx) Transcatheter Aortic Valve Implantation vs. Transaortic (TAo) Transcatheter Aortic Valve Implantation was evaluated on 30-day mortality (RR 0.46, 95% CI 0.31, 0.69, p=0.0001). Transaxillary TAVI significantly reduced 30-day mortality compared to the transaortic approach (4.2% vs. 9.6%, RR 0.46) in patients with aortic stenosis.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: