Transradial vs transfemoral secondary access outcomes in transcatheter aortic valve implantation: A systematic review and meta-analysis

Table 1 Characteristics and procedure details of included studies

	Junquera et al[2]	Fernandez-Lopez et al[6]	Jackson et al[5]	Allende et al[4]	Curran et al[3]
Study details
Year of publication	2020	2018	2018	2014	2014
Country of origin	Multinational (Canada, Europe)	France	The United Kingdom	Canada	Italy
Number of centers	Multicenter	Single center	Single center	Single center	Single center
Study design	Retrospective and prospective cohort study	Retrospective and prospective cohort study	Retrospective cohort study	Retrospective cohort study	Retrospective cohort study
Study subjects	A total of 4949 patients who underwent TAVI between 2007 and 2018 in 10 tertiary centers were included. Selection of secondary access was up to the heart team. 3906 subjects had matched outcomes	Retrospective cohort of 194 patients underwent TFSA TAVI between Sept 2015 and Apr 2016. Prospective cohort of 217 pts underwent TRSA TAVI between April 2016 and May 2017	All consecutive TAVI cases between May 2015 and June 2017 included. Default TRSA used for all non-TF TAVIs from Jan 2016. Prior to this, secondary access was selected based on clinical grounds	Consecutive patients who underwent TAVI from 2007 to 2014 enrolled. From May 2007-Jan 2013, TFSA was chosen. From Jan 2013 onwards, TRSA was chosen in TFPA TAVI and some non-TFPA TAVI	A total of 87 consecutive patients who underwent TFPA TAVI between June 2011 and March 2012 were included in the study. The first 46 TRSA candidates and 41 TFSA candidates were considered
Primary access	TF + non-TF	TF only	TF + non-TF	TF + non-TF	TF only
Total No. of study subjects (APA) with matched or adjusted data if available	3906 (TRSA = 928, TFSA = 2978)	411 (TRSA = 217, TFSA = 194)	199 (TRSA = 135, TFSA = 64)	462 (TRSA = 127, TFSA = 335)	87 (TRSA = 46, TFSA = 41)
Total No. of study subjects (TFPA) with matched or adjusted data	NA	411 (TRSA = 217, TFSA = 194)	179 (TRSA = 115, TFSA = 64)	221 (TRSA = 118, TFSA = 103)	87 (TRSA = 46, TFSA = 41)
Definition of bleeding and vascular events	VARC-2 criteria	VARC-2 criteria	VARC-2 criteria	VARC-2 criteria	Original VARC criteria
Limitations of study	Nonrandomized study	(1) Non-randomized study; (2) Relatively small sample size; (3) TFSA technique was novel resulting in a learning curve	(1) Non-randomized study; (2) Relatively small sample size; (3) Unclear if there was a difference in the populations (risk adjustment not reported)	(1) Non-randomized study; (2) Relatively small sample size; (3) Low use of percutaneous closure devices (13%) for obtaining hemostasis in TFSA	(1) Non-randomized study; (2) Relatively small sample size; (3) TFSA technique was novel resulting in a learning curve
Was risk-adjustment done?	Both unadjusted and propensity score-matched data available	Adjusted for age, Euroscore, BMI, NYHA class, type, and size of valve	Not reported	Adjusted for gender and peripheral disease	Not reported
TAVI Procedure details
Hemostasis of PA	TFPA—Percutaneous in 76.3%, surgical cutdown in 23.7%	TFPA—ProGlide device	TFPA—2 ProGlide devices	TFPA—surgical cutdown	NA
Hemostasis of TF secondary access	Manual compression (24%), ProGlide (39%), Angio-Seal (37%)	Angio-Seal or ProGlide	NA	Manual compression (87%), ProGlide (8%), Angio-Seal (5%)	NA
Post-closure angiography?					No angiography was performed systematically in TFPA

TF: Transfemoral; TR: Transradial; APA: All primary access; TFPA: Transfemoral primary access; TFSA: Transfemoral secondary access; TRSA: Transradial secondary access; TAVI: Transcatheter aortic valve implantation; NYHA: New York Heart Association; BMI: Body mass index; VARC: Valve Academic Research Consortium; NA: Not available.

Table 2 Demographic comparison based on secondary access of matched/adjusted data (if available)

	Junquera et al[2]		Fernandez-Lopez et al[6]		Jackson et al[5]		Allende et al[4]		Curran et al[3]
	TFSA (n = 2978)	TRSA (n = 928)	TFSA (n = 194)	TRSA (n = 217)	TFSA (n = 64)	TRSA (n = 135)	TFSA (n = 335)	TRSA (n = 127)	TFSA (n = 41)	TRSA (n = 46)
Baseline characteristics of patients
Age	81 ± 4	81 ± 8	83 ± 7	82 ± 6	82 ± 6	82 ± 7	79 ± 8	80 ± 9	80 ± 10	80 ± 5
%Male	52.60%	53.20%	44.80%	53.50%	57.00%	43.00%	45.00%	61.00%	31.70%	52.20%
Baseline comorbidities
Diabetes	26.90%	27.00%	31.40%	24.40%	20.00%	20.00%	35.00%	31.00%	30.00%	26.10%
HTN	-	-	56.70%	55.30%	-	-	88.00%	84.00%	92.50%	80.40%
CAD	51.20%	50.30%	-	-	53.00%	52.60%	67.00%	63.00%	-	-
Previous CABG	19.80%	19.60%	4.10%	6.00%	20.00%	19.30%	39.00%	33.00%	17.10%	17.40%
AFib	33.50%	34.70%	27.80%	33.60%	25.00%	25.00%	17.00%	20.00%	-	-
PVD	16.30%	19.20%	13.40%	14.30%	18.00%	26.70%	40.00%	24.00%	-	-
Prior CVA	-	-	10.30%	10.60%	17.00%	16.30%	19.00%	16.00%	-	-
eGFR < 60 mL/min/1.73 m2	67.60%	69.40%	-	-	-	-	57.00%	51.00%	-	-
COPD/Pul disease	21.30%	20.90%	11.90%	13.40%	25.00%	25.90%	29.00%	25.00%	20.00%	13.00%
STS-PROM score	4.5	4.7	5.0 ± 3.0	4.8 ± 3.6	-	-	7.1 ± 4.5	7.2 ± 5.0	9.0 ± 7.8	7.2 ± 7.5
Valve type
Balloon-expandable	60.00%	63.50%	NA	NA	NA	NA	96.00%	88.00%	NA	NA
Self-expandable	40.00%	36.50%	NA	NA	NA	NA	3.00%	10.00%	NA	NA
1° Access
TFPA	88.50%	89.90%	100%	100%	100%	85.20%	30.80%	93.00%	100%	100%
Non-TFPA	11.50%	10.10%	0	0	0	14.80%	69.20%	7.00%	0	0
Transapical	9.10%					3.70%	58.20%	6.00%
Transaortic	1.90%					8.80%	10.70%	1.00%
Subclavian	1.50%					2.20%	0.30%	0
Transcarotid	4.06%					0	0	0
Transcaval	0.12%					0	0	0

TFSA: Transfemoral secondary access; TRSA: Transradial secondary access; HTN: Hypertension; CAD: Coronary artery disease; CABG: Coronary artery bypass graft; AFib: Atrial fibrillation; PVD: Peripheral vascular disease; CVA: Cerebrovascular event; eGFR: Estimated glomerular filtration rate; COPD: Chronic obstructive pulmonary disease; STS-PROM: Society of thoracic surgeons predicted risk of mortality; TFPA: Transfemoral primary access.