1. Femoral Versus Nonfemoral Subclavian/Carotid Arterial Access Route for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis
- Author
-
Siamak Mohammadi, Laurent Faroux, Lucia Junquera, Dimitri Kalavrouziotis, Robert DeLarochellière, Guillem Muntané-Carol, Josep Rodés-Cabau, Alberto Alperi, Eric Dumont, David del Val, and Jean-Michel Paradis
- Subjects
medicine.medical_specialty ,Transcatheter aortic ,medicine.medical_treatment ,transsubclavian ,Subclavian Artery ,Aortic Valve Replacement/Transcather Aortic Valve Implantation ,030204 cardiovascular system & hematology ,Risk Assessment ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Valve replacement ,Internal medicine ,Catheterization, Peripheral ,medicine ,Humans ,030212 general & internal medicine ,Stroke ,Ischemic Stroke ,transcarotid ,Access route ,business.industry ,Systematic Review and Meta‐analysis ,Aortic Valve Stenosis ,medicine.disease ,stroke ,Femoral Artery ,Carotid Arteries ,Meta-analysis ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - 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.
- Published
- 2020