Key result
Trans-subclavian access for TAVI had comparable 30-day mortality to trans-femoral access (OR 0.75; 95% CI 0.49-1.16; p=0.195) but significantly lower major vascular complications.
Why the study?
The subclavian artery offers an alternative access route for TAVI in patients unsuitable for traditional femoral access, but its safety and efficacy compared to the transfemoral approach required evaluation.
Does the trans-subclavian approach reduce complications compared to the trans-femoral approach in patients undergoing TAVI?
Meta-Analysis (n=2,938)
Does the trans-subclavian approach reduce complications compared to the trans-femoral approach in patients undergoing TAVI?
Trans-subclavian access is a safe and feasible alternative to transfemoral access for TAVI, associated with lower risks of major vascular complications.
The subclavian artery is an alternative access route for transcatheter aortic valve implantation (TAVI), with a potential advantage in patients unsuitable for traditional access routes such as the femoral artery. This study aimed to determine the safety and efficacy of the trans-subclavian (TSc) compared to the trans-femoral (TF) approach. A systematic review was conducted on two online databases: Embase and Medline. The initial search returned 508 titles. Nine observational studies were included: n = 2938 patients (2382 TF and 556 TSc). Both TSc and TF groups were comparable for: 30-day mortality (Odds ratio, OR 0.75, 95% CI 0.49 – 1.16, p = 0.195); in-hospital stroke (OR 1.05, 95% CI 0.60–1.85, p = 0.859); myocardial infarction (OR 1.97, 95% CI 0.74–5.23, p = 0.176); paravalvular leaks (OR 1.20, 95% CI 0.76–1.90, p = 0.439); rates of postoperative permanent pacemaker implantation (OR 1.49, 95% CI 0.92–2.41, p = 0.105); in-hospital bleeding and meta-analysis demonstrated no significant difference between access points (OR 3.44, 95% CI 0.35–34.22, p = 0.292). Procedural time was found to be longer in the TSc group (SMD 1.02; 95% CI 0.815–1.219, p < 0.001). Major vascular complications were significantly higher in the TF group (OR 0.55, 95% CI 0.32–0.94, p = 0.029). Meta regression found no influence of the covariates on the outcomes. Subclavian access is both a safe and feasible alternative access route for TAVI with lower risks of major vascular complications. This study supports the use of subclavian access as a viable alternative in patient groups where transfemoral TAVI is contraindicated.
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Al‐Balah et al. (2020) conducted a meta-analysis in Transcatheter aortic valve implantation (TAVI) (n=2,938). Trans-subclavian (TSc) approach vs. Trans-femoral (TF) approach was evaluated on 30-day mortality (OR 0.75, 95% CI 0.49-1.16, p=0.195). Trans-subclavian access for TAVI had comparable 30-day mortality to trans-femoral access (OR 0.75; 95% CI 0.49-1.16; p=0.195) but significantly lower major vascular complications.
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