Key result
Transcaval TAVR yields ~6% 30-day mortality in patients ineligible for transfemoral access.
Why the study?
The transcaval approach is increasingly used for TAVR in patients unsuitable for transfemoral access, motivating an evaluation of its efficacy, safety, and clinical outcomes.
Does transcaval transcatheter aortic valve replacement provide safe and effective outcomes in patients with severe aortic stenosis unsuitable for the transfemoral approach?
Meta-Analysis (n=467)
Does transcaval transcatheter aortic valve replacement provide safe and effective outcomes in patients with severe aortic stenosis unsuitable for the transfemoral approach?
Transcaval TAVR is a viable and safe alternative access strategy with reassuring mortality and complication rates for patients who cannot undergo standard transfemoral TAVR.
Supports transcaval TAVR in transfemoral-ineligible patients; extends sparse observational data but leaves randomized confirmation open.
BACKGROUND: The transcaval (TCv) vascular approach is increasingly used in transcatheter aortic valve replacement (TAVR) in patients unsuitable for the gold-standard transfemoral approach. We aimed to evaluate the efficacy, safety, and clinical outcomes associated with TCv-TAVR. METHODS: A systematic review and meta-analysis was conducted by searching PubMed/Medline, Embase, and the Cochrane Library for all articles assessing the TCv approach published through December 2023. Outcomes included 30-day and 1-year all-cause mortality (ACM), 30-day rehospitalisation, perioperative complications and postoperative complications at 30 days. The meta-analysis was registered on the PROSPERO database with the identifier CRD42024501921. RESULTS: A total of 8 studies with 467 patients were included. TCv-TAVR procedures achieved a success rate of 98.5%. TCv-TAVR was associated with a 30-day ACM rate of 6.1% (95% confidence interval [CI]: 3.9%-8.2%), a 1-year ACM rate of 14.9% (95% CI 2.3%-27.6%) and a 30-day rehospitalisation rate of 4.2% (95% CI -2.2% to 10.6%). Postoperative stroke or transient ischemic attack, major vascular complications, and major or life-threatening bleeding occurred in 3.3%, 8.7%, and 7.5% of cases, respectively. Cumulative meta-analyses showed a temporal trend of decreasing rates of vascular complications. CONCLUSIONS: The TCv approach in TAVR demonstrated a reassuring efficacy and safety profile, with mortality and postoperative complication rates similar to those reported for supra-aortic alternative TAVR access routes. The temporal decrease in vascular complications suggests potential improvements in procedural techniques and device technology. These findings further support the TCv approach as a viable option in patients ineligible for the transfemoral access. PROSPERO: CRD42024501921.
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Salihu et al. (2024) conducted a meta-analysis in severe aortic stenosis unsuitable for transfemoral TAVR (n=467). Transcaval transcatheter aortic valve replacement was evaluated on 30-day all-cause mortality (95% CI 3.9-8.2). Transcaval transcatheter aortic valve replacement demonstrated a 30-day all-cause mortality rate of 6.1%, showing a reassuring safety profile for patients ineligible for transfemoral access.
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