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Meta-Analysis
. 2020 Oct 20;9(19):e017460.
doi: 10.1161/JAHA.120.017460. Epub 2020 Sep 29.

Femoral Versus Nonfemoral Subclavian/Carotid Arterial Access Route for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Laurent Faroux  1 , Lucia Junquera  1 , Siamak Mohammadi  1 , David Del Val  1 , Guillem Muntané-Carol  1 , Alberto Alperi  1 , Dimitri Kalavrouziotis  1 , Eric Dumont  1 , Jean-Michel Paradis  1 , Robert Delarochellière  1 , Josep Rodés-Cabau  1
Affiliations
Meta-Analysis

Femoral Versus Nonfemoral Subclavian/Carotid Arterial Access Route for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Laurent Faroux et al. J Am Heart Assoc. .

Abstract

Background Some concerns remain regarding the safety of transcarotid and transsubclavian approaches for transcatheter aortic valve replacement. We aimed to compare the risk of 30-day complications and death in transcarotid/transsubclavian versus transfemoral transcatheter aortic valve replacement recipients. Methods and Results Data from 20 studies, including 79 426 patients (16 studies) and 3992 patients (4 studies) for the evaluation of the unadjusted and adjusted impact of the arterial approach were sourced, respectively. The use of a transcarotid/transsubclavian approach was associated with an increased risk of stroke when using unadjusted data (risk ratio [RR], 2.28; 95% CI, 1.90-2.72) as well as adjusted data (odds ratio [OR], 1.53; 95% CI, 1.05-2.22). The pooled results deriving from unadjusted data showed an increased risk of 30-day death (RR, 1.46; 95% CI, 1.22-1.74) and bleeding (RR, 1.53; 95% CI, 1.18-1.97) in patients receiving transcatheter aortic valve replacement through a transcarotid/transsubclavian access (compared with the transfemoral group), but the associations between the arterial access and death (OR, 1.22; 95% CI, 0.89-1.69), bleeding (OR, 1.05; 95% CI, 0.68-1.61) were no longer significant when using adjusted data. No significant effect of the arterial access on vascular complication was observed in unadjusted (RR, 0.84; 95% CI, 0.66-1.06) and adjusted (OR, 0.79; 95% CI, 0.53-1.17) analyses. Conclusions Transcarotid and transsubclavian approaches for transcatheter aortic valve replacement were associated with an increased risk of stroke compared with the transfemoral approach. However, these nonfemoral arterial alternative accesses were not associated with an increased risk of 30-day death, bleeding, or vascular complication when taking into account the confounding factors.

Keywords: stroke; transcarotid; transcatheter aortic valve replacement; transsubclavian.

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Conflict of interest statement

Dr Faroux received fellowship support from Institut Servier and the Association Régionale de Cardiologie de Champagne‐Ardenne (ARCCA), and research grant from Biotronik, Edwards Lifesciences, and Medtronic. Dr Rodés‐Cabau has received institutional research grants from Edwards Lifesciences, Medtronic, and Boston Scientific. The remaining authors have no disclosures to report. Dr Rodés‐Cabau holds the Research Chair “Fondation Famille Jacques Larivière” for the Development of Structural Heart Disease Interventions. Drs. Junquera, Del Val, Muntané‐Carol and Alperi were supported by a grant from the Fundacion Alfonso Martin Escudero (Madrid, Spain).

Figures

Figure 1
Figure 1. Flowchart of selected studies.
Flowchart, based on the Preferred Reported Items for Systematic Reviews and Meta‐Analysis (PRISMA) statement, of studies selected comparing outcomes of transsubclavian or transcarotid to transfemoral approach for transcatheter aortic valve replacement recipients.
Figure 2
Figure 2. Risk of 30‐day all‐cause death after transcatheter aortic valve replacement according to the arterial approach.
A, Studies without propensity‐score matching 8 , 10 , 11 , 14 , 15 , 16 , 17 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ; B, Studies with propensity‐score matching. 27 , 28 , 29 , 30
Figure 3
Figure 3. Risk of periprocedural stroke after transcatheter aortic valve replacement according to the arterial approach.
A, Studies without propensity‐score matching; B, Studies with propensity‐score matching. 27 , 28 , 29 , 30
Figure 4
Figure 4. Risk of bleeding after transcatheter aortic valve replacement according to the arterial approach.
A, Studies without propensity‐score matching 8 , 10 , 11 , 15 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 26 ; B, Studies with propensity‐score matching. 27 , 28 , 29 , 30
Figure 5
Figure 5. Risk of vascular complication after transcatheter aortic valve replacement according to the arterial approach.
A, Studies without propensity‐score matching; B, Studies with propensity‐score matching. 27 , 28 , 29 , 30
See this image and copyright information in PMC

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