Abstract 4144113: Comparative Safety and Efficacy of Transfemoral versus Subclavian Approaches in Transcatheter Aortic Valve Implantation: A Meta-Analysis

Background: Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive procedure for high-risk aortic stenosis patients. While the transfemoral approach is traditionally preferred, the subclavian route is gaining recognition as a feasible alternative when transfemoral access is not viable. However, a detailed comparison of the safety and efficacy between these two approaches is not well-established. Objective: This meta-analysis aims to rigorously compare the safety and efficacy of the transfemoral and subclavian approaches in TAVI procedures. Methods: A comprehensive literature search was performed across PubMed, EMBASE, Cochrane Library, and Scopus databases up to December 2022. Studies that compared the transfemoral and subclavian TAVI approaches to various clinical outcomes were included. Statistical analyses were conducted using R software (version 4.0.3) with metafor and meta packages, and results were synthesized using Odds Ratios (OR) within a random-effects model framework. Results: The search identified 11 relevant studies involving 11,787 patients (10,740 transfemoral TAVI and 1,047 subclavian TAVI). Comparative analysis revealed no significant differences between the two approaches in procedure success (OR 1.36; 95% CI 0.86-2.15; P=0.19; I2=0%), in-hospital mortality (OR 0.77; 95% CI 0.45-1.31; P=0.33; I2=0%), 30-day mortality (OR 1.07; 95% CI 0.75-1.52; P=0.71; I2=0%), stroke incidence (OR 0.89; 95% CI 0.55-1.47; P=0.67; I2=0%), vascular complications (OR 1.26; 95% CI 0.67-2.39; P=0.47; I2=68%), significant bleeding events (OR 0.79; 95% CI 0.49-1.26; P=0.32; I2=0%), and myocardial infarction rates (OR 0.49; 95% CI 0.19-1.32; P=0.16; I2=0%). Conclusion: This meta-analysis demonstrates that both transfemoral and subclavian TAVI approaches offer comparable safety and efficacy profiles. The choice of approach should be individualized based on patient characteristics, operator expertise, and resource availability. The absence of significant differences and the broad confidence intervals highlight the need for larger, randomized trials to validate these findings further and explore potential clinical nuances.