Key result
Transcaval TAVR shows no mortality difference compared to supra-aortic access.
Why the study?
Data comparing transcaval to supra-aortic approaches (transcarotid, transsubclavian, and transaxillary) as alternative vascular accesses for TAVR were lacking.
Does transcaval access reduce in-hospital or 30-day all-cause mortality and postoperative complications compared to supra-aortic access in patients unfit for transfemoral TAVR?
Meta-Analysis (n=497)
Does transcaval access reduce in-hospital or 30-day all-cause mortality and postoperative complications compared to supra-aortic access in patients unfit for transfemoral TAVR?
Transcaval access yields safety and mortality outcomes comparable to supra-aortic approaches, establishing it as a viable first-line alternative to transfemoral TAVR in eligible patients.
Answers are grounded in this paper and cite their sources.
Comparable mortality supports transcaval access as alternative to supra-aortic TAVR; leaves open role pending randomized trials.
A growing body of evidence suggests that extrathoracic vascular accesses for transcatheter aortic valve replacement (TAVR) yield favorable outcomes and can be considered as primary alternatives when the gold-standard transfemoral access is contraindicated. Data comparing the transcaval (TCv) to supra-aortic (SAo) approaches (transcarotid, transsubclavian, and transaxillary) for TAVR are lacking. We aimed to compare the outcomes and safety of TCv and SAo accesses for TAVR as alternatives to transfemoral TAVR. A systematic review with meta-analysis was performed by searching PubMed/MEDLINE and EMBASE databases for all articles comparing TCv-TAVR against SAo-TAVR published until September 2023. Outcomes included in-hospital or 30-day all-cause mortality (ACM) and postoperative complications. A total of three studies with 318 TCv-TAVR and 179 SAo-TAVR patients were included. No statistically significant difference was found regarding in-hospital or 30-day ACM (relative risk [RR] 1.04, 95% confidence interval [CI] 0.47–2.34, p = 0.91), major bleeding, the need for blood transfusions, major vascular complications, and acute kidney injury. TCv-TAVR was associated with a non-statistically significant lower rate of neurovascular complications (RR 0.39, 95%CI 0.14–1.09, p = 0.07). These results suggest that both approaches may be considered as first-line alternatives to transfemoral TAVR, depending on local expertise and patients’ anatomy. Additional data from long-term cohort studies are needed.
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Antiochos et al. (2024) conducted a meta-analysis in Patients requiring TAVR who are unfit for transfemoral access (n=497). Transcaval access for TAVR vs. Supra-aortic access (transcarotid, transsubclavian, or transaxillary) was evaluated on In-hospital or 30-day all-cause mortality (RR 1.04, 95% CI 0.47-2.34, p=0.91). Transcaval access for TAVR resulted in no significant difference in in-hospital or 30-day all-cause mortality compared to supra-aortic access (RR 1.04).
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