Percutaneous versus surgical transaxillary access for transcatheter aortic valve replacement: a propensity-matched analysis of the US experience

Chung, Christine; Kaneko, Tsuyoshi; Tayal, Rajiv; Dahle, Thom G.; McCabe, James M.

doi:10.4244/eij-d-21-00549

Cited by 8 publications

(6 citation statements)

References 25 publications

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“…Unfortunately, the analysis was not sufficiently powered to evaluate the individual components of the primary endpoint. Nevertheless, the stroke rates for the IVL and TAX patients were in line with previous reports [ 2 , 22 , 23 ].…”

Section: Discussionsupporting

confidence: 91%

“…Since the decline of transapical access in recent years, TAX has become the main alternative access strategy in most centers. Despite benefits over other alternative access strategies, an elevated periprocedural risk compared to TF has been shown, in particular regarding periprocedural strokes [ 2 , 22 , 23 ]. Pushing the TF route with IVL assistance may hence be a valid option in patients with hostile iliofemoral anatomies.…”

Section: Discussionmentioning

confidence: 99%

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Intravascular Lithotripsy-Assisted Transfemoral Transcatheter Aortic Valve Implantation in Patients with Severe Iliofemoral Calcifications: Expanding Transfemoral Indications

Linder,

Grundmann,

Kellner

et al. 2024

JCM

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(1) Background: Transfemoral transcatheter aortic valve implantation (TAVI) has become the standard treatment for most patients with severe symptomatic aortic stenosis. Intravascular lithotripsy may facilitate transfemoral TAVI (IVL-TAVI) even in patients with severely calcified iliofemoral disease. We assessed technical aspects and clinical outcomes of this novel approach compared to alternative transaxillary access (TAX-TAVI). (2) Methods: IVL-TAVI was performed for severe iliofemoral calcifications precluding standard transfemoral access in 30 patients from 2019 to 2022 at a single academic heart center. IVL was performed as part of the TAVI procedure in all cases. Results were compared to a control group of 44 TAX-TAVI procedures performed for the same indication from 2016 to 2021. The safety outcome was a composite of all-cause death, stroke, access-related bleeding ≥ type 2 within 24 h and major vascular access site complications at 30 days. The efficacy outcome was defined as a technical success according to VARC-3. (3) Results: Median age was 78.2 [74.3, 82.6] years, 45.9% were female and mean STS-PROM was 3.6% [2.3, 6.0]. Iliofemoral calcifications were more severe in the IVL-TAVI vs. TAX-TAVI groups (lesion length: 63.0 mm [48.6, 80.3] vs. 48.5 mm [33.1, 68.8]; p = 0.043, severe calcification at target lesion: 90.0% vs. 68.2%; p = 0.047, and median arc calcification 360.0° [297.5, 360.0] vs. 360.0° [180.0, 360.0]; p = 0.033). Technical success was achieved in 93.3% vs. 81.8% (p = 0.187) in IVL- and TAX-TAVI and the safety outcome occurred in 10.0% vs. 31.8% in IVL- and TAX-TAVI (p = 0.047), respectively. (4) Conclusions: IVL-assisted transfemoral TAVI was feasible and safe with favorable outcomes compared to TAX-TAVI. IVL may further expand the number of patients eligible for transfemoral TAVI and may help overcome limitations of an alternative access.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Intravascular Lithotripsy-Assisted Transfemoral Transcatheter Aortic Valve Implantation in Patients with Severe Iliofemoral Calcifications: Expanding Transfemoral Indications

Linder,

Grundmann,

Kellner

et al. 2024

JCM

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“…Percutaneous access can be used for transaxillary access and may increase the risk for vascular complications. An analysis of the Society of Toracic Surgeons and American College of Cardiology Transcatheter Valve Terapy (STS/ACC TVT) Registry found that percutaneous access was pursued in 27% of all TAx-TAVRs and was associated with a signifcantly higher rate of major vascular complications compared to surgical cutdown [23]. Te overwhelming majority of transaxillary access in the studies included in our analysis appear to have been done with a surgical cutdown, although this was not always explicitly stated.…”

Section: Discussionmentioning

confidence: 94%

Comparison of Alternative Peripheral and Transfemoral Approaches for Transcatheter Aortic Valve Replacement: A Meta-Analysis of Propensity-Matched Studies

McGrath

Sun

Kawabori

et al. 2023

Journal of Cardiac Surgery

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Background. Transfemoral (TF) access is the gold standard for transcatheter aortic valve replacement (TAVR). Alternative peripheral (AP) artery access such as the carotid or axillary artery is considered when the feasibility of femoral access is in doubt. The outcomes comparison of these 2 approaches is unclear due to limited sample sizes in prior studies. Our aim is to compare the clinical outcomes of TF- and AP-TAVR by conducting a meta-analysis of propensity-matched studies. Methods. The PubMed, EMBASE, and Cochrane Library databases from inception up to and including February 2022 were searched by 3 separate researchers to identify articles reporting propensity-matched, comparative data on TF vs. AP-TAVR. Clinical outcomes were extracted from the articles and pooled for analysis. Results. Seven prior studies, including 9,004 patients, were included in our study, with 6,729 in the TF group and 2,275 in the AP group. In all studies, the baseline characteristics of the patients were highly propensity-matched with the full Newcastle-Ottawa scale. Meta-analysis revealed higher in-hospital/30-day mortality (3.3% vs. 4.4%; OR 0.69; 95% CI (0.51, 0.94); P = 0.02 ) as well as the incidence of stroke (1.9% vs. 3.5%; OR 0.60; 95% CI (0.43, 0.84); P = 0.003 ) for the AP group. There were no significant differences in the incidence of major vascular complications, pacemaker implantation, bleeding, or acute kidney injury. Conclusions. Our meta-analysis of propensity-matched studies showed AP-TAVR contains an additional 1.1% risk of early mortality and an additional 1.6% risk of stroke compared to TF-TAVR. These risks should be considered when deciding on access.

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“…In a study where 44.1% of patients received stent-grafts, major vascular complications were noted in 14.3% of cases 5 . In a propensity-matched analysis of percutaneous versus surgical transaxillary access in TAVR, major vascular complications occurred in 3.0% versus 1.5% of the respective groups; however, the exact definition for these complications is not provided in the report 4 . In another study where the average hospital stay was 1.2 days, with 83% of cases being discharged the following day, no bleeding or vascular complications were documented 6 .…”

Section: Discussionmentioning

confidence: 99%

Percutaneous transaxillary approach through the first segment of the axillary artery for the Impella-supported PCI Versus TAVR

Sacha,

Krawczyk,

Gwóźdź

et al. 2024

Sci Rep

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Percutaneous transaxillary approach (PTAX) through the first segment of the axillary artery is not widely recognized as a safe method. Furthermore, PTAX has never been directly compared between Impella-supported percutaneous coronary interventions (Impella-PCI) and transcatheter aortic valve replacement (TAVR). This study evaluated the feasibility and safety of PTAX through the first axillary segment in Impella-PCI versus TAVR. In cases where standard imaging guidance was insufficient, a technique involving puncturing the axillary artery “on-the-balloon” was employed. The endpoints were bleeding and vascular complications, as defined by BARC and VARC-3 criteria. PTAX was successfully performed in all 46 attempted cases: 23 for Impella-PCI and 23 for TAVR. Strict adherence to BARC and VARC-3 criteria led to the frequent identification of major bleeding (57%) and a moderately frequent diagnosis of vascular complications (17%). These incidences were primarily based on post-procedural hemoglobin reduction (> 3 g/dl) but not overt bleeding. The Impella group exhibited a higher rate of BARC 3b bleeding due to a greater hemoglobin decline resulting from the prolonged implant duration and PCI itself. Left axillary access was linked to smaller blood loss. Bleeding and vascular complications, as per BARC and VARC-3 definitions, did not affect short-term prognosis, with only 3 Impella patients succumbing to heart failure unrelated to the procedures during one-month follow-up period.

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Percutaneous versus surgical transaxillary access for transcatheter aortic valve replacement: a propensity-matched analysis of the US experience

Cited by 8 publications

References 25 publications

Intravascular Lithotripsy-Assisted Transfemoral Transcatheter Aortic Valve Implantation in Patients with Severe Iliofemoral Calcifications: Expanding Transfemoral Indications

Intravascular Lithotripsy-Assisted Transfemoral Transcatheter Aortic Valve Implantation in Patients with Severe Iliofemoral Calcifications: Expanding Transfemoral Indications

Comparison of Alternative Peripheral and Transfemoral Approaches for Transcatheter Aortic Valve Replacement: A Meta-Analysis of Propensity-Matched Studies

Percutaneous transaxillary approach through the first segment of the axillary artery for the Impella-supported PCI Versus TAVR

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