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Review
. 2020 Nov 6:31:100668.
doi: 10.1016/j.ijcha.2020.100668. eCollection 2020 Dec.

Comparison of outcomes following transfemoral versus trans-subclavian approach for transcatheter aortic valve Implantation: A meta-analysis

Amer Al-Balah  1 , Danial Naqvi  1 , Nour Houbby  1 , Lueh Chien  1 , Sayan Sen  2 , Thanos Athanasiou  3 , M Yousuf Salmasi  3
Affiliations
Review

Comparison of outcomes following transfemoral versus trans-subclavian approach for transcatheter aortic valve Implantation: A meta-analysis

Amer Al-Balah et al. Int J Cardiol Heart Vasc. .

Abstract

Background: The subclavian artery is an alternative access route for transcatheter aortic valve implantation (TAVI), with a potential advantage in patients unsuitable for traditional access routes such as the femoral artery. This study aimed to determine the safety and efficacy of the trans-subclavian (TSc) compared to the trans-femoral (TF) approach.

Methods: A systematic review was conducted on two online databases: Embase and Medline. The initial search returned 508 titles. Nine observational studies were included: n = 2938 patients (2382 TF and 556 TSc).

Results: Both TSc and TF groups were comparable for: 30-day mortality (Odds ratio, OR 0.75, 95% CI 0.49 - 1.16, p = 0.195); in-hospital stroke (OR 1.05, 95% CI 0.60-1.85, p = 0.859); myocardial infarction (OR 1.97, 95% CI 0.74-5.23, p = 0.176); paravalvular leaks (OR 1.20, 95% CI 0.76-1.90, p = 0.439); rates of postoperative permanent pacemaker implantation (OR 1.49, 95% CI 0.92-2.41, p = 0.105); in-hospital bleeding and meta-analysis demonstrated no significant difference between access points (OR 3.44, 95% CI 0.35-34.22, p = 0.292). Procedural time was found to be longer in the TSc group (SMD 1.02; 95% CI 0.815-1.219, p < 0.001). Major vascular complications were significantly higher in the TF group (OR 0.55, 95% CI 0.32-0.94, p = 0.029). Meta regression found no influence of the covariates on the outcomes.

Conclusion: Subclavian access is both a safe and feasible alternative access route for TAVI with lower risks of major vascular complications. This study supports the use of subclavian access as a viable alternative in patient groups where transfemoral TAVI is contraindicated.

Keywords: Femoral artery; Subclavian artery; Transcatheter aortic valve; Vascular complications.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1A
Fig. 1A
Flow diagram demonstrating study selection process.
Fig. 1B
Fig. 1B
Funnel plot analysis demonstrating low evidence of publication bias.
Fig. 2
Fig. 2
Forest plots: meta-analysis of the incidence of short-term complications following following transcatheter aortic valve implantation in two vascular access groups: transfemoral (TF) and trans-subclavian (TSc). A 30-day mortality. B post-procedural stroke. C post-procedural myocardial infarction. D major in-hospital bleeding. E major vascular complications. D major in-hospital bleeding. E major vascular complications. F early paravalvular leak. G permanent pacemaker (PPM) insertion.
Fig. 2
Fig. 2
Forest plots: meta-analysis of the incidence of short-term complications following following transcatheter aortic valve implantation in two vascular access groups: transfemoral (TF) and trans-subclavian (TSc). A 30-day mortality. B post-procedural stroke. C post-procedural myocardial infarction. D major in-hospital bleeding. E major vascular complications. D major in-hospital bleeding. E major vascular complications. F early paravalvular leak. G permanent pacemaker (PPM) insertion.
Fig. 2
Fig. 2
Forest plots: meta-analysis of the incidence of short-term complications following following transcatheter aortic valve implantation in two vascular access groups: transfemoral (TF) and trans-subclavian (TSc). A 30-day mortality. B post-procedural stroke. C post-procedural myocardial infarction. D major in-hospital bleeding. E major vascular complications. D major in-hospital bleeding. E major vascular complications. F early paravalvular leak. G permanent pacemaker (PPM) insertion.
Fig. 2
Fig. 2
Forest plots: meta-analysis of the incidence of short-term complications following following transcatheter aortic valve implantation in two vascular access groups: transfemoral (TF) and trans-subclavian (TSc). A 30-day mortality. B post-procedural stroke. C post-procedural myocardial infarction. D major in-hospital bleeding. E major vascular complications. D major in-hospital bleeding. E major vascular complications. F early paravalvular leak. G permanent pacemaker (PPM) insertion.
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