Efficacy and safety of transradial versus transfemoral approach for secondary access in transcatheter aortic valve implantation: a systematic review and meta-analysis.

BACKGROUND

Transcatheter aortic valve implantation (TAVI) requires a primary access to deliver the valve and a secondary access for angiographic guidance. Although transfemoral access (TFA) is most commonly employed, alternative access sites are gaining traction. This systematic review and meta-analysis compares the efficacy and safety of transradial (TRA) and TF secondary access.

METHODS

A literature search was performed on MEDLINE, Embase, Cochrane, and Clinicaltrials.gov from their inception to January 2025. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using the Mantel-Haenzel method for dichotomous outcomes. Mean differences (MD) with 95% confidence intervals (CI) were pooled using the inverse variance method for continuous outcomes. Random-effects meta-analyses were undertaken.

RESULTS

Seven studies, with 15 283 patients, were included. TRA had a significantly lower risk of vascular complications (RR 0.47, 95% CI 0.25-0.89), major vascular complications (RR 0.45, 95% CI:0.27-0.73), bleeding (RR 0.53, 95% CI 0.36-0.78), major bleeding (RR 0.55, 95% CI 0.34-0.90), stroke (RR 0.62, 95% CI 0.39-0.99), all-cause mortality (RR 0.45, 95% CI 0.36-0.57), and acute kidney injury (RR 0.48, 95% CI 0.38-0.60). Both groups were comparable in terms of life-threatening bleeding, myocardial infarction, permanent pacemaker requirement, length of hospital stay, contrast volume, procedure time, and fluoroscopy time.

CONCLUSION

TRA is associated with superior outcomes compared to TFA for secondary access in TAVI. Furthermore, large-scale randomized trials are needed to clarify the most optimal access sites for TAVI.