E-32 | Effect of Hospital Size on Outcomes of Transcatheter Aortic Valve Replacement: A 6-Year Retrospective Analysis in the United States

Background: Transcatheter aortic valve replacement (TAVR) procedures frequently require a second arterial access to perform aortic root angiography.In recent times, there has been an increase in the use of unilateral access, however, the outcomes data are conflicting.Methods: A systematic database search was conducted to retrieve studies comparing unilateral to bilateral access in TAVR.Risk ratios (RR) with 95% confidence intervals (CI) were pooled using the Mantel-Haenszel random-effects model.Outcomes of interest included minor vascular complications, major vascular complications, 30-day stroke, and 30-day all-cause mortality.Results: Three studies with a total of 2,181 patients undergoing TAVR (unilateral 368, bilateral 1813) were included in this meta-analysis.The unilateral access group had 61.4% males with a mean age of 80.9 AE 7.5 years, and the bilateral access group had 50.1% males with a mean age of 81.3 AE 7.5 years.Edwards SAPIEN-3 and SAPIEN-XT were the most used valves across studies.Unilateral access was comparable to bilateral access for minor vascular complications (RR: 0.88; 95% CI: 0.48-1.62),major vascular complications (RR: 0.61, 95% CI: 0.14-2.75),stroke (RR: 0.95; 95% CI: 0.42, 2.17), and all-cause mortality (RR: 0.52; 95% CI: 0.04, 6.93).Conclusions: Unilateral access for TAVR was associated with similar short-term outcomes and safety profiles compared to bilateral access for TAVR.Large-scale, multicenter, randomized controlled trials are needed to validate these findings.