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

Yong Zhan, Siavash Saadat, Avneet Soin, Masashi Kawabori, Frederick Y. Chen


Background: While transfemoral (TF) approach is considered as the default access for transcatheter aortic valve replacement (TAVR), the alternative access route of choice remains to be elucidated. Transaxillary (TAx) approach has shown promise as an excellent option. We performed a meta-analysis of the studies comparing the TF and TAx approaches using one type of self-expandable transcatheter valve to avoid device-related bias.
Methods: We searched PubMed/MEDLINE, EMBASE, and the Cochrane Library from inception to December 2018 to identify articles comparing TAx-TAVR and TF-TAVR. The studies included in this meta- analysis contain data related to the use of the CoreValve device. Patients’ baseline characteristics, procedural outcomes, and clinical outcomes were extracted from the articles and pooled for analysis.
Results: The meta-analysis included five studies comprising 1,414 patients in the TF group and 489 patients in the TAx group. The average EuroScores of the TF and TAx groups were 20.04±13.89 and 22.73±14.73, respectively. The TAx group has higher rates of major comorbidities. No difference was found between the two groups with regard to vascular complications (P=0.71; OR 1.08; 95% CI, 0.71–1.65), aortic regurgitation (P=0.90; OR 1.03; 95% CI, 0.71–1.49), and permanent pacemaker (PPM) implantation (P=0.42; OR 1.12; 95% CI, 0.86–1.46). The TAx group has a lower incidence of acute kidney injury (AKI) (P=0.05; OR 1.63; 95% CI, 1.01–2.62). No difference was observed in 30-day mortality (P=0.32; OR 1.30; 95% CI, 0.78–2.17) or 1-year mortality (P=0.21; OR 0.76; 95% CI, 0.50–1.16).
Conclusions: TAx-TAVR is associated with overall comparable outcomes to TF TAVR in high-risk patient cohorts, despite higher incidences of major comorbidities in the TAx-TAVR patient population. The rate of AKI appears to be lower after TAx-TAVR.