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

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.

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

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.