A meta-analysis comparing transaxillary and transaortic transcatheter aortic valve replacement

Abstract

Background The alternative access route of choice for transcatheter aortic valve replacement (TAVR) remains to be elucidated due to lack of evidences. We performed a meta-analysis comparing the outcomes of two common alternative access routes, transaxillary (TAx) and transaortic (TAo) approaches. Methods The PubMed/MEDLINE, Embase, and Cochrane library from inception to December 2018 were searched to identify the articles reporting data on both TAx-TAVR and TAo-TAVR. Patients' baseline characteristics, procedural outcomes, and clinical outcomes were extracted from the articles and pooled for analysis. Results Four studies, a total of 750 (374 TAo and 376 TAx) patients were included in the study. The two groups were similar in patients' baseline characteristics, although the TAx group comprised few female patients. The two groups differ in outcomes including 30-day mortality, rates of pacemaker implant and acute kidney injury, and length of hospital stay. There were no differences between the two groups with regard to device success, paravalvular leak, stroke, vascular complications, and 1-year mortality. Conclusion Compared with the TAo approach, the TAx approach is associated with favorable short-term mortality, lower incidence of acute kidney injury, and shorter length of hospital stay, but increased pacemaker requirement. TAx could be considered over TAo as the preferred alternative access for TAVR.

Impact of diverse aortic pathologies on outcomes after transapical transcatheter aortic valve replacement

“…In contrast, the most recent studies of other nontransfemoral approaches in usual TAVR populations using the most recently developed valves with very fine delivery systems, such as SAPIEN 3 and SAPIEN 3 Ultra , have shown mortality rates ranging between 4.3% and 5.2%, and stroke rates between 4.2% and 7.4% 13 . Even though our cohort does not necessarily reflect the broader population of patients who cannot undergo other non‐TF approaches, the interventional risk with other nontransfemoral approaches in patients with diverse AP remains high, as recent studies have reported considerably high rates of vascular injuries (between 4.8% and 6.9%) 14 . Lastly, the invasiveness of a procedure depends not only on whether it has been performed percutaneously.…”

“…13 Even though our cohort does not necessarily reflect the broader population of patients who cannot undergo other non-TF approaches, the interventional risk with other nontransfemoral approaches in patients with diverse AP remains high, as recent studies have reported considerably high rates of vascular injuries (between 4.8% and 6.9%). 14 Lastly, the invasiveness of a procedure depends not only on whether it has been performed percutaneously. The TA approach represents an aorta no-touch technique and hence should be considered as the most minimally invasive technique for TAVR in patients with diverse AP for as long as evidence on other approaches is lacking.…”

Transapical‐transcatheter aortic valve implantation in patients without transvascular options: Modified transapical approach

“…Recent studies have reported considerably high rates of vascular injuries (4.8%-6.9%). 13 Interestingly, in the vast majority of the abovementioned studies, no contraindications of the respective approaches (TS, Tax, and TC) have been reported, and the contraindications for these approaches have been poorly studied. This may be one of the reasons why the results of these approaches have not yet matured.…”

Minireview: Transaortic Transcatheter Aortic Valve Implantation: Is There Still an Indication?

“…Purse-string suture and cannulation of the ascending aorta are standard procedures and are performed daily. Therefore, access site complications are not common in the literature and are described are described in 2 to 5% only (17,(22)(23)(24). The TAo access is of particular importance in case of contraindications for TF TAVI and concomitant calcifications of the supra-aortic branches and the aortic arch since under these circumstances other alternative access routes, such as TAx or TC, are not feasible (25).…”

“…Other alternative access (AA) routes, such as transaxillary (TAx) and transcarotid (TC), offer comparable advantages over TA. Several studies have compared these procedures with contrary results in terms of procedural success, perioperative outcome, and mortality (15)(16)(17)(18)(19).…”