Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Nov 26, 2020; 12(11): 571-583
Published online Nov 26, 2020. doi: 10.4330/wjc.v12.i11.571
Transradial vs transfemoral secondary access outcomes in transcatheter aortic valve implantation: A systematic review and meta-analysis
Shree Lata Radhakrishnan, Kalon KL Ho
Shree Lata Radhakrishnan, Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
Kalon KL Ho, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
Author contributions: Radhakrishnan SL completed conceptualization, methodology and formal analysis, wrote original draft, reviewed and edited the manuscript; Ho KKL provided resources and supervision, reviewed and edited the manuscript.
Conflict-of-interest statement: All of the authors report that they have no conflicts of interest to disclose related to this research.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 checklist and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shree Lata Radhakrishnan, MD, Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue W Span 210, Boston, MA 02215, United States. sradhak1@bidmc.harvard.edu
Received: August 21, 2020
Peer-review started: August 21, 2020
First decision: October 5, 2020
Revised: October 21, 2020
Accepted: October 30, 2020
Article in press: October 30, 2020
Published online: November 26, 2020
Processing time: 97 Days and 4.7 Hours
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: Transcatheter aortic valve implantation; Meta-analysis; Femoral access; Radial access; Secondary access; Transcatheter aortic valve replacement

Core Tip: Transcatheter aortic valve implantation (TAVI) procedures can result in complications due to secondary access site. This meta-analysis looks into 5 observational studies that compared outcomes in TAVI related to secondary access. The outcomes included 30-d bleeding, vascular complications, strokes, and mortality. Meta-analysis showed decreased odds of outcomes when transradial secondary access was used over transfemoral.