Extrathoracic Against Intrathoracic Vascular Accesses for Transcatheter Aortic Valve Replacement: A Systematic Review With Meta-Analysis

Abellan, Christophe; Antiochos, Panagiotis; Fournier, Stéphane; Skali, Hicham; Shah, Pinak; Maurizi, Niccolò; Eeckhout, Éric; Roguelov, Christan; Monney, Pierre; Τζίμας, Γεώργιος; Kirsch, Matthias; Müller, Olivier; Lu, Henri

doi:10.1016/j.amjcard.2023.07.091

Cited by 4 publications

(1 citation statement)

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“…During the past decade, in patients unfit for the gold-standard TF vascular approach, SAo-TAVR has become the de facto first-line alternative for many teams worldwide. In a previously published meta-analysis, our team showed that SAo approaches, compared with the transthoracic ones (transapical and transaortic), were associated with lower ACM (30-day or 1-year) and lower rates of post-operative complications (including life-threatening bleeding, new-onset atrial fibrillation or flutter, and AKI needing renal replacement therapy), provided patient groups were not comparable (transthoracic-TAVR patients being more poly-morbid) [17]. Historically, transthoracic approaches were developed first and considered as the primary to TF access until the mid-2010s.…”

Section: Discussionmentioning

confidence: 99%

Transcaval versus Supra-Aortic Vascular Accesses for Transcatheter Aortic Valve Replacement: A Systematic Review with Meta-Analysis

Antiochos,

Kirsch,

Monney

et al. 2024

JCM

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A growing body of evidence suggests that extrathoracic vascular accesses for transcatheter aortic valve replacement (TAVR) yield favorable outcomes and can be considered as primary alternatives when the gold-standard transfemoral access is contraindicated. Data comparing the transcaval (TCv) to supra-aortic (SAo) approaches (transcarotid, transsubclavian, and transaxillary) for TAVR are lacking. We aimed to compare the outcomes and safety of TCv and SAo accesses for TAVR as alternatives to transfemoral TAVR. A systematic review with meta-analysis was performed by searching PubMed/MEDLINE and EMBASE databases for all articles comparing TCv-TAVR against SAo-TAVR published until September 2023. Outcomes included in-hospital or 30-day all-cause mortality (ACM) and postoperative complications. A total of three studies with 318 TCv-TAVR and 179 SAo-TAVR patients were included. No statistically significant difference was found regarding in-hospital or 30-day ACM (relative risk [RR] 1.04, 95% confidence interval [CI] 0.47–2.34, p = 0.91), major bleeding, the need for blood transfusions, major vascular complications, and acute kidney injury. TCv-TAVR was associated with a non-statistically significant lower rate of neurovascular complications (RR 0.39, 95%CI 0.14–1.09, p = 0.07). These results suggest that both approaches may be considered as first-line alternatives to transfemoral TAVR, depending on local expertise and patients’ anatomy. Additional data from long-term cohort studies are needed.

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Section: Discussionmentioning

confidence: 99%