Transcaval access for transcatheter aortic valve replacement: a systematic review and meta-analysis.

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSION

Transcaval access for TAVR is a safe and feasible method that can be considered a new alternative when trans-femoral access is contraindicated.