Transradial vs transfemoral secondary access outcomes in transcatheter aortic valve implantation: A systematic review and meta-analysis

Shree Lata Radhakrishnan; Kalon Kl Ho

doi:10.4330/wjc.v12.i11.571

Transradial vs transfemoral secondary access outcomes in transcatheter aortic valve implantation: A systematic review and meta-analysis

World J Cardiol. 2020 Nov 26;12(11):571-583. doi: 10.4330/wjc.v12.i11.571.

Authors

Shree Lata Radhakrishnan¹, Kalon Kl Ho²

Affiliations

¹ Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States.
² Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States.

Abstract

Background: Complications of transcatheter aortic valve implantation (TAVI) procedures include bleeding, vascular complications, and strokes. These complications are often associated with the type of access used. The two types of access in TAVI procedures are primary and secondary. The main use of the primary access is for valve delivery, while secondary access is used for angiography and hemodynamic monitoring. While there are many options for primary access, those for secondary access are transfemoral and transradial.

Aim: To compare outcomes between transradial vs transfemoral secondary access (TFSA).

Methods: A systematic search was conducted using major databases (EMBASE, PubMed, Cochrane Central, Google Scholar), which resulted in 5 studies that met the criteria for study selection. Outcomes of interest were 30-d rates each of major/life-threatening bleeding, vascular complications, strokes, and mortality. All 5 studies were observational. Only adjusted or matched data were used when available in this meta-analysis.

Results: A total of 5065 patients underwent TAVI, with 1453 patients (28.7%) having undergone transradial secondary access (TRSA) and 3612 patients (71.3%) TFSA. Irrespective of the site of primary access, the odds of having major or life-threatening bleeding were 60% lower in the TRSA group than the TFSA group (P < 0.00001). The odds of having major vascular complications were 52% lower in the TRSA group (P < 0.0001) with no difference in minor vascular complications between the 2 groups. Similarly, the odds of mortality in 30-d after the procedure were 41% lower (P = 0.006) and the odds of stroke were 54% lower (P = 0.001) in the TRSA group than the TFSA group.

Conclusion: The transradial secondary approach appears to be a safer alternative to the transfemoral secondary approach in TAVI procedures.

Keywords: Femoral access; Meta-analysis; Radial access; Secondary access; Transcatheter aortic valve implantation; Transcatheter aortic valve replacement.