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A meta-analysis comparing transaxillary and transaortic transcatheter aortic valve replacement

General Thoracic and Cardiovascular Surgery volume 69, pages 19–26 (2021)Cite this article

Abstract

Background

The alternative access route of choice for transcatheter aortic valve replacement (TAVR) remains to be elucidated due to lack of evidences. We performed a meta‐analysis comparing the outcomes of two common alternative access routes, transaxillary (TAx) and transaortic (TAo) approaches.

Methods

The PubMed/MEDLINE, Embase, and Cochrane library from inception to December 2018 were searched to identify the articles reporting data on both TAx-TAVR and TAo-TAVR. Patients’ baseline characteristics, procedural outcomes, and clinical outcomes were extracted from the articles and pooled for analysis.

Results

Four studies, a total of 750 (374 TAo and 376 TAx) patients were included in the study. The two groups were similar in patients’ baseline characteristics, although the TAx group comprised few female patients. The two groups differ in outcomes including 30-day mortality, rates of pacemaker implant and acute kidney injury, and length of hospital stay. There were no differences between the two groups with regard to device success, paravalvular leak, stroke, vascular complications, and 1-year mortality.

Conclusion

Compared with the TAo approach, the TAx approach is associated with favorable short-term mortality, lower incidence of acute kidney injury, and shorter length of hospital stay, but increased pacemaker requirement. TAx could be considered over TAo as the preferred alternative access for TAVR.

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Affiliations

  1. Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street, #266, Boston, MA, 02111, USA

    Yong Zhan, Serena Lofftus, Masashi Kawabori, Avneet Soin & Frederick Y. Chen

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  1. Yong Zhan
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  2. Serena Lofftus
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  3. Masashi Kawabori
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  4. Avneet Soin
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  5. Frederick Y. Chen
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Correspondence to Yong Zhan.

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Zhan, Y., Lofftus, S., Kawabori, M. et al. A meta-analysis comparing transaxillary and transaortic transcatheter aortic valve replacement. Gen Thorac Cardiovasc Surg 69, 19–26 (2021). https://doi.org/10.1007/s11748-020-01428-w

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  • DOI: https://doi.org/10.1007/s11748-020-01428-w

Keywords

  • Transcatheter aortic valve replacement
  • Transaxillary
  • Transaortic
  • Meta-analysis