Comparison of Transaortic and Subclavian Approaches for Transcatheter Aortic Valve Replacement in Patients with No Transfemoral Access Options

Khan, Asaad; Kovacic, Jason; Engstrom, Krysthel; Stewart, Allan; Anyanwu, Anelechi C.; Basnet, Sandeep; Aquino, Melissa; Baber, Usman; Garcia, Luis; Gidwani, Umesh; Dangas, George; Kini, Annapoorna; Sharma, Samin K.

doi:10.1080/24748706.2018.1497237

Cited by 7 publications

(9 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After removal of duplicates, a review of the titles and abstracts, 168 articles were assessed in full text. Of these, a further 164 studies were excluded, and 4 studies [14][15][16][17] met the inclusion criteria for meta-analysis (Fig. 1).…”

Section: Literature Searchmentioning

confidence: 99%

“…One study [15] involved the use of a single self-expandable valve (Medtronic CoreValve), whereas the other three studies [14,16,17] involved the use of both balloon-expandable valves (Edwards Sapien, XT, or S3) and the self-expanding CoreValve (Table 1). The CoreValve use was 51.8% (24.4-100%) for the TAo group.…”

Section: Device Usementioning

confidence: 99%

“…In the TAx group, except for two patients receiving balloon-expandable valves in one study [16], the rest of TAx patients (99.5%) received the CoreValve. While the use of the self-expandable CoreValve was homogenous throughout the four studies, various balloon-expandable transcatheter heart valves (THV) were used among these studies [14,16,17], with all three types of Edwards THVs (Sapien, XT, or S3) included in one study [14] and Sapien XT in the other study [17]. In one study, authors did not specify the type (s) of the Edwards THV [16].…”

Section: Device Usementioning

confidence: 99%

“…The incidence of acute kidney injury (AKI) was provided by three studies [14,15,17]. The pooled results showed a significant difference between the two groups favoring the TAx group (18.1% vs 20.1%; OR 1.90; 95% CI [1.10, 3.30]; P = 0.02) with no heterogeneity (I 2 = 0%) (Fig.…”

Section: Acute Kidney Injurymentioning

confidence: 99%

See 3 more Smart Citations

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

Zhan

Lofftus

Kawabori

et al. 2020

Gen Thorac Cardiovasc Surg

View full text Add to dashboard Cite

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.

show abstract

Section: Literature Searchmentioning

confidence: 99%

Section: Device Usementioning

confidence: 99%

Section: Device Usementioning

confidence: 99%

Section: Acute Kidney Injurymentioning

confidence: 99%

See 2 more Smart Citations

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

Zhan

Lofftus

Kawabori

et al. 2020

Gen Thorac Cardiovasc Surg

View full text Add to dashboard Cite

show abstract

“…Thus these 31 studies were used in the quantitative meta-analysis ( Fig. 1), with 2,883 and 2,172 patients in the DAo TAVR and TAx TAVR groups, respectively (Adamo et al, 2015;Arai et al, 2016;Bonaros et al, 2017;Bruschi et al, 2017Bruschi et al, , 2015Cocchieri et al, 2019;D'Ancona et al, 2019;Dahle & Rein, 2014;Dahle, Kaneko & McCabe, 2019;Damluji et al, 2018;Fiorina et al, 2017;Gilard et al, 2012;Gleason et al, 2018;Hysi et al, 2019;Jagielak et al, 2015;Khan et al, 2018;Laflamme et al, 2014;Muensterer et al, 2013;Okuyama et al, 2015;Petzina et al, 2017;Ramlawi et al, 2015;Ribeiro et al, 2015;Romano et al, 2019;Ropponen et al, 2016;Schäfer et al, 2017;Spargias et al, 2014;Terzian et al, 2017;Testa et al, 2012;Thourani et al, 2015;Wendt et al, 2015;Zhan et al, 2020).…”

Section: Literature Searchmentioning

confidence: 99%

Direct aortic route versus transaxillary route for transcatheter aortic valve replacement: a systematic review and meta-analysis

Lee

Chen

et al. 2020

PeerJ

View full text Add to dashboard Cite

Background The transfemoral route is contraindicated in nearly 10% of transcatheter aortic valve replacement (TAVR) candidates because of unsuitable iliofemoral vessels. Transaxillary (TAx) and direct aortic (DAo) routes are the principal nonfemoral TAVR routes; however, few studies have compared their outcomes. Methods We performed a systematic review and meta-analysis to compare the rates of mortality, stroke, and other adverse events of TAx and DAo TAVR. The study was prospectively registered with PROSPERO (registration number: CRD42017069788). We searched Medline, PubMed, Embase, and Cochrane databases for studies reporting the outcomes of DAo or TAx TAVR in at least 10 patients. Studies that did not use the Valve Academic Research Consortium definitions were excluded. We included studies that did not directly compare the two approaches and then pooled rates of events from the included studies for comparison. Results In total, 31 studies were included in the quantitative meta-analysis, with 2,883 and 2,172 patients in the DAo and TAx TAVR groups, respectively. Compared with TAx TAVR, DAo TAVR had a lower Society of Thoracic Surgery (STS) score, shorter fluoroscopic time, and less contrast volume use. The 30-day mortality rates were significantly higher in the DAo TAVR group (9.6%, 95% confidence interval (CI) = [8.4–10.9]) than in the TAx TAVR group (5.7%, 95% CI = [4.8–6.8]; P for heterogeneity <0.001). DAo TAVR was associated with a significantly lower risk of stroke in the overall study population (2.6% vs. 5.8%, P for heterogeneity <0.001) and in the subgroup of studies with a mean STS score of ≥8 (1.6% vs. 6.2%, P for heterogeneity = 0.005). DAo TAVR was also associated with lower risks of permanent pacemaker implantation (12.3% vs. 20.1%, P for heterogeneity = 0.009) and valve malposition (2.0% vs. 10.2%, P for heterogeneity = 0.023) than was TAx TAVR. Conclusions DAo TAVR increased 30-day mortality rate compared with TAx TAVR; by contrast, TAx TAVR increased postoperative stroke, permanent pacemaker implantation, and valve malposition risks compared with DAo TAVR.

show abstract

Non-femoral focused transaxillary access in TAVI: GARY data analysis and future trends

Meertens,

Adam,

Beckmann

et al. 2024

Clin Res Cardiol

View full text Add to dashboard Cite

Background In patients not suitable for transfemoral transcatheter aortic valve implantation (TAVI), several access strategies can be chosen. Aim To evaluate the use and patient outcomes of transaxillary (TAx), transapical (TA), and transaortic (TAo) as alternative access for TAVI in Germany; to further evaluate surgical cutdown vs. percutaneous TAx access. Methods All patients entered the German Aortic Valve Registry (GARY) between 2011 and 2019 who underwent non-transfemoral TAVI were included in this analysis. Patients with TA, TAo, or TAx TAVI were compared using a weighted propensity score model. Furthermore, a subgroup analysis was performed for TAx regarding the percutaneous or surgical cutdown approach. Results Overall, 9686 patients received a non-transfemoral access. A total of 8918 patients (92.1%) underwent TA, 398 (4.1%) TAo, and 370 (3.8%) TAx approaches. Within the TAx subgroup, 141 patients (38.1%) received subclavian cutdown, while 200 (54.1%) underwent a percutaneous approach. The TA patients had a significantly lower 30-day survival than TAx patients (TA 90.92% vs. TAx 95.59%, p = 0.006; TAo 92.22% vs. TAx 95.59%, p = 0.102). Comparing percutaneous and cutdown TAx approaches, no significant differences were seen. However, more vascular complications occurred (TA 1.8%, TAo 2.4%, TAx 12.2%; p < .001), and the hospital length of stay was shorter (TA 12.9 days, TAo 14.1 days, TAx 12 days; p < .001) after TAx access. Conclusion It may be reasonable to consider TAx access first in patients not suitable for TF-TAVI, because the 30-day survival was higher compared with TA access and the 1-year survival was higher compared with TAo access. It remains important for the heart teams to offer alternative access modalities for patients not amenable to the standard TF-TAVI approaches. Graphical Abstract

show abstract

Comparison of Transaortic and Subclavian Approaches for Transcatheter Aortic Valve Replacement in Patients with No Transfemoral Access Options

Cited by 7 publications

References 20 publications

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

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

Direct aortic route versus transaxillary route for transcatheter aortic valve replacement: a systematic review and meta-analysis

Non-femoral focused transaxillary access in TAVI: GARY data analysis and future trends

Contact Info

Product

Resources

About