Premium
Transubclavian approach: A competitive access for transcatheter aortic valve implantation as compared to transfemoral
Author(s) -
AmatSantos Ignacio J.,
Rojas Paol,
Gutiérrez Hipólito,
Vera Silvio,
Castrodeza Javier,
Tobar Javier,
GoncalvesRamirez L. Renier,
Carrasco Manuel,
Catala Pablo,
San Román José A.
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27485
Subject(s) - medicine , stenosis , odds ratio , cardiology , percutaneous , dialysis , aortic valve stenosis , aortic valve replacement , stroke (engine) , surgery , mechanical engineering , engineering
Aims Empirically, transfemoral (TF) approach is the first choice for transcatheter aortic valve implantation (TAVI). We aimed to investigate whether transubclavian (TSc) and TF approaches present comparable major outcomes according to current evidence. Methods We systematically searched PubMed, EMBASE, and Cochrane database for studies with symptomatic aortic stenosis patients who underwent TAVI through TF or TSc/axillary access from January/2006 to January/2017. Searched terms were: (“aortic stenosis” OR “transcatheter aortic” OR “TAVI” OR “TAVR”) and (“transfemoral” OR “transaxillary” OR “transubclavian”). Major outcomes according to Valve Academic Research Consortium‐2 criteria were gathered. The odds ratio (OR) was used as a summary statistic. A random‐effects model was used. A fully percutaneous TSc TAVI case from our institution illustrates minimalist approach. Results Final analysis was made with six studies including 4,504 patients (3,886 TF and 618 TSc). Baseline characteristics of compared groups in individual studies were similar, with the exception of a higher logistic EuroSCORE in the TSc group (23.7 ± 1.92 vs. 21.17 ± 3.51, P = 0.04) and higher prevalence of coronary and peripheral artery disease with OR = 0.67 [95% CI: 0.54–0.83] ( P = 0.0003) and OR = 0.08 [95% CI: 0.05–0.12] ( P < 0.00001), respectively. TSc group presented comparable 30‐day mortality (OR = 1.37; [95%CI: 0.85–2.21]; P = 0.20). There were no differences for procedural success, 30‐day stroke rate, need for new pacemaker implantation, major vascular complications, and acute kidney injury requiring dialysis. Also, no differences were found concerning 1‐year mortality. Conclusions Our study suggests that TSc approach may be, not only an alternative route to TF approach for TAVI, but even a competitive one in certain patients with increased risk of femoral injury.