2-Year Results of CoreValve Implantation Through the Subclavian Access
Key result
Subclavian TAVI matches femoral 2-year survival but is linked to less AKI and minor vascular complications.
- P=0.78
- n=282
Why the study?
The subclavian approach represents an alternative for TAVI when femoral access is unfeasible, but comparative procedural and 2-year outcomes versus the femoral approach needed evaluation.
Does the subclavian approach for TAVI provide similar procedural success and 2-year survival compared to the femoral approach?
Population
141 subclavian TAVI patients matched to 141 femoral TAVI patients from the Italian CoreValve Registry
Comparison
Subclavian TAVI approach vs femoral TAVI approach
Design
Registry-based propensity score-matched cohort study
Follow-up
2 years
Authors
Discussion
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Implication
Subclavian access appears comparable to femoral in matched registry patients; leaves open randomized validation of equivalence.
Key Points
- To evaluate the procedural outcomes and 2-year clinical results of subclavian access compared with transfemoral access for transcatheter aortic valve implantation.
- Included consecutive patients undergoing subclavian TAVI from the Italian CoreValve Registry.
- Conducted propensity score matching to pair 141 subclavian access patients with 141 transfemoral access patients.
- Procedural success was achieved in 97.9% of subclavian patients versus 96.5% of femoral patients (p = 0.47), with similar combined safety endpoint rates (19.9% vs. 25.5%; p = 0.26).
- Subclavian access showed significantly lower rates of stage 3 acute kidney injury (4.3% vs. 9.9%; p = 0.02) and minor access-site vascular complications (2.1% vs. 11.3%; p = 0.003).
- Two-year overall survival was 74.0 ± 4.0% in the subclavian group versus 73.7 ± 3.9% in the femoral group (p = 0.78), with freedom from cardiovascular mortality reaching 87.2 ± 3.1% versus 88.7 ± 2.8% (p = 0.84).
Study Design
Type
Cohort (n=282)
Multicenter
Yes
Structured PICO
Does the subclavian approach for TAVI provide similar procedural success and 2-year survival compared to the femoral approach?
P
Population
282 propensity-matched patients (median age 83 years, 39% female) undergoing transcatheter aortic valve implantation via subclavian or femoral approach, followed for 2 years.
E
Exposure
Transcatheter aortic valve implantation (TAVI) using the subclavian approach with the CoreValve prosthesis.
C
Comparator
Transcatheter aortic valve implantation (TAVI) using the femoral approach (propensity-matched group).
O
Outcome
Procedural success and 2-year survival.hard clinical
Main Result
Absolute Event Rate: 74% vs 73.7%
p-value: p=0.78
The subclavian approach for TAVI is a safe and feasible alternative to the femoral approach, yielding similar 2-year survival and procedural success with potentially fewer minor vascular and renal complications.
Cite This Study
Petronio et al. (2012) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=282). Subclavian approach vs. Femoral approach was evaluated on Survival at 2 years (p=0.78). The subclavian approach for TAVI yielded similar 2-year survival compared to the femoral approach (74.0% vs. 73.7%; p=0.78), with lower rates of acute kidney injury and minor vascular complications.