Key result
Percutaneous axillary access for TAVI was associated with a lower risk of major adverse events compared to surgical access (OR 0.44; 95% CI 0.21-0.95; P=0.036).
Why the study?
Percutaneous axillary access for TAVI holds promise for improving safety without compromising effectiveness compared to surgical access, but comparative effectiveness data were needed.
Does percutaneous axillary access reduce major adverse events compared to surgical axillary access in patients undergoing TAVI?
Observational (n=432)
Yes
Does percutaneous axillary access reduce major adverse events compared to surgical axillary access in patients undergoing TAVI?
Odds Ratio: 0.44 (95% CI 0.21–0.95)
p-value: p=0.036
Percutaneous axillary access for TAVI is associated with fewer major adverse events and shorter hospital stays compared to surgical access, though it carries a higher risk of primary hemostasis failure.
May favor percutaneous axillary access for TAVI; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an established management strategy for severe aortic valve stenosis. Percutaneous axillary approach for TAVI holds the promise of improving safety without jeopardizing effectiveness in comparison to surgical access. We aimed at appraising the comparative effectiveness of percutaneous vs. surgical axillary approaches for TAVI. METHODS: We performed an international retrospective observational study using de-identified details on baseline, procedural, and 1-month follow-up features. Valve Academic Research Consortium (VARC)-3 criteria were applied throughout. Outcomes of interest were clinical events up to 1 month of follow-up, compared with unadjusted and propensity score-adjusted analyses. RESULTS: A total of 432 patients were included, 189 (43.8%) receiving surgical access, and 243 (56.2%) undergoing percutaneous access. Primary hemostasis failure was more common in the percutaneous group (13.2% vs. 4.2%, P<0.001), leading to more common use of covered stent implantation (13.2% vs. 3.7%, P<0.001). Irrespectively, percutaneous access was associated with shorter hospital stay (-2.6 days [95% confidence interval: -5.0; -0.1], P=0.038), a lower risk of major adverse events (a composite of death, myocardial infarction, stroke, type 3 bleeding, and major access-site related complication; odds ratio=0.44 [0.21; 0.95], P=0.036), major access-site non-vascular complications (odds ratio=0.21 [0.06; 0.77], P=0.018), and brachial plexus impairment (odds ratio=0.16 [0.03; 0.76], P=0.021), and shorter hospital stay (-2.6 days [-5.0; -0.1], P=0.038). CONCLUSIONS: Percutaneous axillary access provides similar or better results than surgical access in patients undergoing TAVI with absolute or relative contraindications to femoral access.
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Giordano et al. (2022) conducted an observational in Severe aortic valve stenosis (n=432). Percutaneous axillary access vs. Surgical axillary access was evaluated on Major adverse events (composite of death, myocardial infarction, stroke, type 3 bleeding, and major access-site related complication) (OR 0.44, 95% CI 0.21-0.95, p=0.036). Percutaneous axillary access for TAVI was associated with a lower risk of major adverse events compared to surgical access (OR 0.44; 95% CI 0.21-0.95; P=0.036).
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