Transcaval access for transcatheter aortic valve implantation: A meta-analysis and systematic review

Bishoy Abraham, Mina Sous, Sara Kaldas, Michael Nakhla, John Sweeney, Kwan Lee, Santiago Garcia, Marwan Saad, Sachin S. Goel, F. David Fortuin

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Anatomical factors may preclude transfemoral (TF) arterial access for transcatheter aortic valve implantation (TAVI). Transcaval (TCav) access has been utilized as an alternative access for these patients. We aimed to investigate the outcomes of TCav access in patients undergoing TAVI. Methods: We performed a systematic review and meta-analysis including all published studies from 1996 to November 2023 that examined TCav access in patients undergoing TAVI. The main outcomes included all cause mortality, major vascular complications, major bleeding, stroke, and myocardial infarction (MI). Outcomes were reported at 30-day and 1-year follow-up. Results: We included 8 observational studies with a total of 517 patients (mean age 78.1±8 years, 56.6 % women, mean STS score 7 ± 4.5). Mean (SD) procedure time was 35 ± 9.8 mins and mean (SD) contrast volume was 136.3 ± 77.4 ml. Procedure success was achieved in 94.3 % of the patients. At 30-day follow-up, all-cause mortality occurred in 6.4 %, major bleeding in 12.2 %, blood transfusion in 23.3 %, retroperitoneal bleeding in 19 %, major vascular complications in 7.9 %, MI in 2.8 %, and AKI in 6.4 % of patients. At 1-year, all-cause mortality was 14.7 %. In a sub-group analysis including 3 studies comparing TCav (n = 316) to alternative accesses (including transcarotid, transaxillary, and transapical) (n = 303), there were no differences in all-cause mortality, major bleeding, major vascular complications, blood transfusion, or stroke at 30-day. Conclusion: Transcaval approach is feasible and non-inferior to other alternative accesses in TAVI patients with prohibitive iliofemoral anatomy.

Original languageEnglish (US)
Article number132720
JournalInternational Journal of Cardiology
Volume419
DOIs
StatePublished - Jan 15 2025

Keywords

  • Aortic valve stenosis
  • TAVI
  • Transcaval access

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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