Otmani Zina, Alzawahreh Ahmad, Awad Abdelaziz A, Khalefa Basma Badrawy, Elsayed Hazem Ayman, Amin Omar Hany Mohamed, Abouzid Mohamed, Almansi Amjad, Awad Ayman K
Faculty of Medicine, Mouloud Mammeri University, Tizi Ouzou, Algeria.
Faculty of Medicine, The Hashemite University, Zarqa, Jordan.
Ann Med Surg (Lond). 2025 Mar 28;87(5):2914-2927. doi: 10.1097/MS9.0000000000003193. eCollection 2025 May.
Transfemoral access is considered the standard route for transcatheter aortic valve replacement (TAVR). However, in some cases, this access route is contraindicated. Alternative access routes, such as transaxillary, are emerging as first-line approaches to address these limitations, while the transcaval approach remains uncertain. Our Meta-analysis aims to evaluate the safety of the transcaval approach compared to other access routes for TAVR.
We searched five databases, PubMed, SCOPUS, Web of Science, Cochrane Library, and Embase, from inception until April 2024 for any study that reports transcaval access alone or compares it to any alternative access in TAVR patients. We used Risk ratio (RR) for dichotomous outcomes and Mean Difference (MD) for continuous outcomes with a 95% confidence interval.
Eleven studies with 1003 patients were included, transcaval showed non-statistically significant difference over alternatives in terms of intra-hospital, 30 days, and long-term all-cause mortality with a RR of 0.08 (95% CI -0.83 to 0.99, = 0.86), 0.11 (95% CI -0.48 to 0.7, = 0.71), and 1.08 (95% CI -0.50 to 2.66, = 0.18), respectively. Furthermore, in our single-arm analysis, transcaval access has a low pooled 30-day all-cause mortality rate of 7% (95% CI 5-10) and long-term mortality of 21% (95% CI 2-77). The mean difference in length of stay in the hospital after the operation was 4.88 (95% CI 4.45-5.31), and the major bleeding rate was 14% (95% CI 8-23).
Transcaval access for TAVR is a safe and feasible method that can be considered a new alternative when trans-femoral access is contraindicated.
经股动脉入路被认为是经导管主动脉瓣置换术（TAVR）的标准入路。然而，在某些情况下，这种入路是禁忌的。替代入路，如经腋动脉入路，正成为解决这些局限性的一线方法，而经腔静脉入路的情况仍不明确。我们的荟萃分析旨在评估与TAVR的其他入路相比，经腔静脉入路的安全性。
我们检索了五个数据库，即PubMed、SCOPUS、科学网、Cochrane图书馆和Embase，从数据库建立至2024年4月，查找任何单独报告经腔静脉入路或在TAVR患者中将其与任何替代入路进行比较的研究。对于二分法结局，我们使用风险比（RR），对于连续结局，我们使用均差（MD），并给出95%置信区间。
纳入了11项研究，共1003例患者，经腔静脉入路在院内、30天和长期全因死亡率方面与其他入路相比无统计学显著差异，RR分别为0.08（95%CI -0.83至0.99，P = 0.86）、0.11（95%CI -0.48至0.7，P = 0.71）和1.08（95%CI -0.50至2.66，P = 0.18）。此外，在我们的单臂分析中，经腔静脉入路的30天全因死亡率汇总率较低，为7%（95%CI 5 - 10），长期死亡率为21%（95%CI 2 - 77）。术后住院时间的平均差异为4.88（95%CI 4.45 - 5.31），大出血率为14%（95%CI 8 - 23）。
TAVR的经腔静脉入路是一种安全可行的方法，当经股动脉入路禁忌时可被视为一种新的替代方法。
