Transaxillary Versus Transfemoral Access for Transcatheter Aortic Valve Implantation: A Propensity Score-Matched Comparison of Clinical Outcomes Using VARC-3 Endpoints

Figures

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  Figure 1. Study flowchart. Among 2389 TAVI procedures screened (January 2016–December 2024), 291 patients with complete data and follow-up were included. After stratification by access route and exclusion of one TAx patient with missing propensity score covariates, 1:2 greedy nearest-neighbor propensity score matching yielded a final cohort of 150 patients (50 TAx, 100 TF). TAx, transaxillary access; TF, transfemoral access; PSM, propensity score matching; VARC-3, Valve Academic Research Consortium-3.

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  Figure 2. Love plot showing standardized mean differences (SMD) for nine propensity score covariates before (orange diamonds) and after (blue circles) matching. The dashed vertical line indicates the SMD = 0.1 adequacy threshold. All nine covariates achieved SMD < 0.1 after matching. DM, diabetes mellitus; HT, hypertension; CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; CKD, chronic kidney disease; LVEF, left ventricular ejection fraction.

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  Figure 3. Box plots showing pre- and post-procedural mean aortic gradient (mmHg; left panel) and left ventricular ejection fraction (LVEF, %; right panel) in the TAx and TF groups. Dark blue and light blue boxes represent TAx pre- and post-procedural values, respectively; orange and light orange boxes represent TF values. Bracket annotations indicate within-group pre-to-post significance (* p < 0.05; p-value displayed if not significant). Post-procedural between-group comparison (TAx vs. TF) is shown in the upper right corner of each panel. LVEF, left ventricular ejection fraction.

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  Figure 4. Stacked bar chart of bleeding events classified according to VARC-3 criteria in the TAx (n = 50) and TF (n = 100) groups. * Total any-bleeding rates were 8.0% in the TAx group and 22.0% in the TF group (p = 0.039). The difference was predominantly driven by Type 1 (minor) access-site bleeding events (TAx 4.0% vs. TF 16.0%). VARC-3, Valve Academic Research Consortium-3.

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  Figure 5. Forest plot of clinical outcomes comparing TAx versus TF access in the propensity score-matched cohort (n = 150). Odds ratios (squares) with 95% confidence intervals on a logarithmic scale are shown. Red filled squares indicate statistically significant differences (p < 0.05); orange indicates trend-level differences (p < 0.10); blue indicates non-significant results. The dashed vertical line denotes OR = 1.0. Patient event counts (TAx/TF) are displayed in the right-hand columns. VARC-3, Valve Academic Research Consortium-3; AR, aortic regurgitation; AKI, acute kidney injury; PPM, permanent pacemaker implantation.

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  Figure 6. Panel (A): Kaplan–Meier curves for 1-year overall survival in the TAx (dark blue solid line) and TF (orange dashed line) groups. Shaded areas represent 95% confidence intervals. Numbers at risk are shown below the time axis. Log-rank p = 0.505. Panel (B): Bar chart comparing intraprocedural, 30-day, and 1-year all-cause mortality rates between the TAx and TF groups. ns, not significant. TAx, transaxillary access; TF, transfemoral access.