Key result
Transsubclavian TAVR shows no mortality difference versus transfemoral TAVR but links to more stroke and bleeding.
Why the study?
Transsubclavian access has emerged as an alternative to transfemoral access for TAVR in patients with hostile iliofemoral anatomy, but clinical outcomes comparing the two approaches using self-expanding devices required investigation.
Does transsubclavian TAVR compared to transfemoral TAVR improve clinical outcomes in patients with severe aortic valve stenosis treated with self-expanding devices?
Cohort (n=892)
No
Does transsubclavian TAVR compared to transfemoral TAVR improve clinical outcomes in patients with severe aortic valve stenosis treated with self-expanding devices?
Hazard Ratio: 2.27 (95% CI 0.8–6.42)
Absolute Event Rate: 6.7% vs 2.7%
p-value: p=0.12
Transsubclavian TAVR is a feasible alternative when transfemoral access is unsuitable, with no significant difference in adjusted 30-day mortality, though it carries a higher risk of stroke and major bleeding likely due to higher baseline patient risk.
TS-TAVR may serve as a safe alternative in hostile femoral anatomy; leaves open need for randomized confirmation with self-expanding devices.
Introduction Transsubclavian (TS) access has emerged as a rapidly growing alternative to the traditional transfemoral (TF) approach in patients with hostile iliofemoral access undergoing transcatheter aortic valve replacement (TAVR). The aim of this study was to investigate clinical outcomes following TS-TAVR and TF-TAVR in severe aortic valve stenosis treated with self-expanding devices. Methods We conducted a single-center retrospective analysis of consecutive patients undergoing TS- or TF-TAVR between August 2017 and May 2025 at our department. Clinical endpoints were reported according to the Valve Academic Research Consortium-3 (VARC 3) criteria. Results A total of 817 patients underwent TF-TAVR, while 75 patients underwent TS-TAVR. Patients undergoing TS-TAVR were more frequently men, presented with a higher Euro Score II, and carried a greater burden of atherosclerotic disease. Unadjusted data analysis showed a significant association between TS access and 30-day mortality [HR 2.64, 95% CI: 1.00–6.97, p = 0.05], stroke [HR 2.44, 95% CI: 1.19–5.01, p = 0.01], myocardial infarction [HR 4.31, 95% CI: 1.16–15.96, p = 0.03], major bleeding [HR 1.79, 95% CI: 1.17–2.73, p = 0.007], and cardiovascular hospitalization [HR 1.65, 95% CI: 1.02–2.65, p = 0.01]. After risk adjustment, the access site remained independently associated with stroke and major bleeding, while 30-day mortality and cardiovascular hospitalization lost statistical significance. Conclusion Overall, TS-TAVR appears to be a feasible approach when TF-TAVR is not possible. Adjusted data revealed no statistically significant association with early mortality. However, the access site was significantly associated with stroke and major bleeding, findings likely attributable to the higher baseline risk of the subclavian cohort in our study.
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Baysal et al. (2026) conducted a cohort in Severe aortic valve stenosis (n=892). Transsubclavian TAVR vs. Transfemoral TAVR was evaluated on All-cause mortality at 30 days (HR 2.27, 95% CI 0.8-6.42, p=0.12). Transsubclavian TAVR showed no statistically significant association with 30-day mortality compared to transfemoral TAVR after risk adjustment (HR 2.27), though it was associated with higher rates of stroke and major bleeding.
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