A Meta-Analysis of Transradial versus Transfemoral approach for secondary vascular access in Transfemoral-Transcatheter aortic valve implantation

Background:
Transradial approach(TRA) has emerged as an alternative to Transfemoral approach (TFA) for secondary access in Transfemoral Transcatheter Aortic Valve Replacement (TF-TAVR). We conducted this meta-analysis to evaluate the efficacy and safety of TRA as a secondary access site compared to TFA for TF-TAVR.

Methods:
PubMed, Cochrane and Web of Science databases were systematically searched. Outcomes of interest were procedural success rates and 30 day complications according to VARC-2 criteria. The analysis was performed using DerSimonian and Laird random effect model. OR and 95% CI were calculated.

Results:
Four studies met our inclusion criteria with a total of 898 patients (TRA: 496; TFA: 402). There was no statistically significant difference in preoperative risk assessment between two groups as compared by STS score (Stand. mean diff: -0.07; 95% CI -0.22 to 0.07, p=0.32) and log Euroscore (Stand. mean diff:-0.17;95%CI -0.72 to 0.38, p=0.54). Procedural success rates, procedure time and contrast volume used were comparable between the two groups. When compared with TFA, TRA had significantly lower incidence of major bleeding events (OR: 0.48; 95% CI: 0.29 to 0.79, p=0.004), access site complications (OR: 0.45; 95% CI: 0.29 to 0.68, p=0.0002); and stroke (OR: 0.28; 95% CI: 0.10 to 0.74, p=0.01). No statistically significant difference was observed in the incidence of AKI, MI and all-cause 30-day mortality.

Conclusions:
Our analysis shows that TRA is an effective and safe alternative to TFA for secondary vascular access in TF-TAVR with significantly lower rates of major bleeding events, access site complications and incidence of stroke.