Comparison of Transfemoral Versus Transradial Secondary Access in Transcatheter Aortic Valve Replacement

Abstract

Background: Transfemoral approach has been commonly used as secondary access in transcatheter aortic valve replacement (TAVR). Scarce data exist on the use and potential clinical benefits of the transradial approach as secondary access during TAVR procedures. The objective of the study is to determine the occurrence of vascular complications (VC) and clinical outcomes according to secondary access (transfemoral versus transradial) in patients undergoing TAVR. Methods: This was a multicenter study including 4949 patients who underwent TAVR (mean age, 81±8 years, mean Society of Thoracic Surgeons score, 4.9 [3.3–7.5]). Transfemoral and transradial approaches were used as secondary access in 4016 (81.1%) and 933 (18.9%) patients, respectively. The 30-day clinical events (vascular and bleeding complications, stroke, acute kidney injury, and mortality) were evaluated and defined according to Valve Academic Research Consortium-2 criteria. Clinical outcomes were analyzed according to the secondary access (transfemoral versus transradial) in the overall population and in a propensity score-matched population involving 2978 transfemoral and 928 transradial patients. Results: Related-access VC occurred in 834 (16.9%) patients (major VC, 5.7%) and were related to the secondary access in 172 (3.5%) patients (major VC, 1.3%). The rate of VC related to the secondary access was higher in the transfemoral group (VC, 4.1% versus 0.9%, P <0.001; major VC, 1.6% versus 0%, P <0.001). In the propensity score-matched population, VC related to the secondary access remained higher in the transfemoral group (4.7% versus 0.9%, P <0.001; major VC, 1.8% versus 0%, P <0.001), which also exhibited a higher rate of major/life-threatening bleeding events (1.0% versus 0%, P <0.001). Significant differences between secondary access groups were observed regarding the rates of 30-day stroke (transfemoral: 3.1%, transradial: 1.6%; P =0.043), acute kidney injury (transfemoral: 9.9%, transradial: 5.7%; P <0.001), and mortality (transfemoral: 4.0%, transradial: 2.4%, P =0.047). Conclusions: The use of transradial approach as secondary access in TAVR procedures was associated with a significant reduction in vascular and bleeding complications and improved 30-day outcomes. Future randomized studies are warranted.

Transcatheter Aortic Valve Implantation: All Transfemoral? Update on Peripheral Vascular Access and Closure

“…Influenced by data coming from coronary angiogram and percutaneous coronary intervention showing a significant reduction in vascular access-related complication using radial vs. femoral access ( 53 ), radial secondary access for TAVI has been progressively used. Encouraging results have been reported by a multicenter registry including 4,949 patients undergoing TAVI using as secondary access either a transfemoral or transradial access (81.1 and 18.9%, respectively) ( 54 ). VARC-2 defined secondary access-related complication rate was significantly higher in the transfemoral vs. transradial group with similar results after propensity score matching (4.7 vs. 0.9%, p < 0.001; major vascular complication, 1.8 vs. 0%, p < 0.001).…”

“…VARC-2 defined secondary access-related complication rate was significantly higher in the transfemoral vs. transradial group with similar results after propensity score matching (4.7 vs. 0.9%, p < 0.001; major vascular complication, 1.8 vs. 0%, p < 0.001). Moreover, the transfemoral group suffered also from a higher 30-day stroke rate (3.1 vs. 1.6%, p = 0.043, respectively) and mortality (4.0 vs. 2.4%, p = 0.047, respectively) ( 54 ).…”

“…Crossover was traditionally performed through a contra-lateral femoral access. However, radial secondary access has been recently use to reduce access-related vascular complication rate ( 54 ). As a consequence, a modified crossover technique through the secondary radial access has been suggested with encouraging results ( 58 , 59 ).…”

Updates on the Latest Surgical Approach of the Aortic Stenosis

“…The transapical access is progressively being abandoned as a result of its invasiveness and poor outcomes. These drawbacks encouraged operators to master other less morbid alternative pathways [84][85][86].…”

Distal Radial Secondary Access for Transcatheter Aortic Valve Implantation: The Minimalistic Approach

“…The transradial approach (TRA) as secondary access in TAVI has become the preferred access site due to its significant reduction in (overall and major) vascular and bleeding periprocedural events (approximately 25% of periprocedural access VCs are related to the transfemoral secondary access [1]). Distal radial access (dRA) at the anatomical snuffbox has been reported [2][3][4] as a safe and feasible unique alternative to TRA at the wrist [3].…”