Key result
Transaxillary TAVI demonstrated an excellent procedural success rate of 92.2% and a 30-day mortality of 5.2%, with clinical outcomes comparable to other alternative TAVI approaches.
Why the study?
When transfemoral TAVI is not feasible, alternative access techniques are needed, with a growing preference towards transaxillary access that warrants summarization and comparison to other approaches.
Does transaxillary TAVI provide comparable procedural success and clinical outcomes to alternative access routes in patients undergoing TAVI?
Systematic Review (n=1,519)
Does transaxillary TAVI provide comparable procedural success and clinical outcomes to alternative access routes in patients undergoing TAVI?
Transaxillary access is a feasible and safe alternative for TAVI with excellent procedural success and comparable clinical outcomes to other access routes, though evidence is currently limited to observational data.
Supports transaxillary TAVI as a viable alternative access route; extends systematic evidence for nonfemoral approaches when transfemoral is unsuitable.
Background: Transfemoral transcatheter aortic valve implantation (TAVI) has proven non-inferior or superior against surgical aortic valve replacement (SAVR) for patients at high, intermediate or low surgical risk. However, transfemoral access is not always feasible in patients with severely atherosclerotic or tortuous iliofemoral arteries. For these cases, alternative access techniques have been developed, such as transcarotid, transcaval, direct aortic or transaxillary access. In recent years, growing preference towards the transaxillary access has emerged. To provide a summary of data available on transaxillary TAVI and compare this approach to other alternative access techniques. Methods: A literature search was performed in PubMed by two independent reviewers. Studies reporting the outcome of at least 10 patients who underwent transaxillary TAVI, either in case series or in comparative studies, were included in this review. Articles not reporting outcomes according to the Valve Academic Research Consortium (VARC) 1–3 definitions were excluded. Results: In total 193 records were found of which 18 were withheld for inclusion in this review. This review reports on the combined data of the 1519 patients who underwent transaxillary TAVI. Procedural success was achieved in 1203 (92.2%) of 1305 cases. Life-threatening, major, and minor bleeding occurred respectively in 4.5% (n = 50 in 1112 cases), 12.9% (n = 143 in 1112 cases) and 8.8% (n = 86 in 978 cases). Major and minor vascular complications were reported in respectively 6.6% (n = 83 in 1256 cases) and 10.0% (n = 105 in 1048 cases) of patients. 30-day mortality was 5.2% (n = 76 out of 1457 cases). At one year follow-up, the mortality rate was 1% (n = 184 out of 1082 cases). Similar 30-day and 1-year mortality is observed in studies that compare with transaxillary, transfemoral or other alternative access techniques (p > 0.05). Conclusions: A wide application of transaxillary access as an alternative approach for TAVI has emerged. This technique has an excellent procedural success rate up to 92.0%, with low procedural complication rates. Clinical outcome of transaxillary TAVI is comparable to the other alternative TAVI approaches. However, these conclusions are solely based on observational data.
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Herremans et al. (2023) conducted a systematic review in Severe aortic valve stenosis (n=1,519). Transaxillary transcatheter aortic valve implantation (TAVI) vs. Alternative TAVI access routes (transfemoral, transthoracic, transcarotid) or none was evaluated on Procedural success. Transaxillary TAVI demonstrated an excellent procedural success rate of 92.2% and a 30-day mortality of 5.2%, with clinical outcomes comparable to other alternative TAVI approaches.
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