Why is this study important?

• Two commonly used alternate access routes have seemingly been used with greater frequency over the last few years, each with various concerns about complications and outcomes. 
• This propensity-weighted retrospective analysis of experienced centers/operators performing high volumes of cases from each access route showed a strong correlation with the transcaval route to fewer strokes and fewer bleeding complications with higher rates of discharge to home as compared to the transaxiallary approach. 
   

What question was this study supposed to answer? 

• To date, there has been a concern about higher stroke rates with the transaxillary approach; this makes the argument further that the transaxiallary approach is associated with higher stroke rates as compared with the transcaval approach.  
• Since the 2017 IDE study for transcaval access came out, there has always been a concern regarding procedural complications.  This study demonstrates that in the hands of experienced operators/centers, these complications are much less than the weighted means in the preceding studies. Refinement of technique is improving outcomes.  

What did the study show?   

• This better highlights the gap in understanding that in alternate access patients undergoing TAVR, the transcaval approach is associated with similar outcomes with regard to discharge to home and stroke as those undergoing a transfemoral approach.  
• For patients undergoing TAVR via an alternate access, this data suggests fewer complications (especially with regard to stroke and bleeding) with the transcaval approach as compared to the transaxillary approach.  

 
All authors: Matthew Wiisanen, MD, FSCAI