Efficacy and safety of transradial versus transfemoral approach for secondary access in transcatheter aortic valve implantation: a systematic review and meta-analysis

Background: Transcatheter aortic valve implantation (TAVI) requires a primary access to deliver the valve and a secondary access for angiographic guidance. Although transfemoral access (TFA) is most commonly employed, alternative access sites are gaining traction. This systematic review and meta-analysis compares the efficacy and safety of transradial (TRA) and TF secondary access. Methods: A literature search was performed on MEDLINE, Embase, Cochrane, and Clinicaltrials.gov from their inception to January 2025. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using the Mantel-Haenzel method for dichotomous outcomes. Mean differences (MD) with 95% confidence intervals (CI) were pooled using the inverse variance method for continuous outcomes. Random-effects meta-analyses were undertaken. Results: Seven studies, with 15 283 patients, were included. TRA had a significantly lower risk of vascular complications (RR 0.47, 95% CI 0.25-0.89), major vascular complications (RR 0.45, 95% CI:0.27-0.73), bleeding (RR 0.53, 95% CI 0.36-0.78), major bleeding (RR 0.55, 95% CI 0.34-0.90), stroke (RR 0.62, 95% CI 0.39-0.99), all-cause mortality (RR 0.45, 95% CI 0.36-0.57), and acute kidney injury (RR 0.48, 95% CI 0.38-0.60). Both groups were comparable in terms of life-threatening bleeding, myocardial infarction, permanent pacemaker requirement, length of hospital stay, contrast volume, procedure time, and fluoroscopy time. Conclusion: TRA is associated with superior outcomes compared to TFA for secondary access in TAVI. Furthermore, large-scale randomized trials are needed to clarify the most optimal access sites for TAVI.