PULSE Registry Subanalysis: Radial vs. Femoral Secondary Access

In view of its lower complications rate, the transfemoral approach is the most used in transcatheter aortic valve replacement (TAVR), vs. alternative access sites. In addition to a primary access for device deployment, a secondary access is needed for pigtail catheter placement to guide prosthesis implantation. In most cases, a second transfemoral puncture is performed for secondary access.  

However, current evidence has associated secondary access with higher risk of access-related vascular complications. The transradial approach appears safer vs. the transfemoral; still, there are no specific studies assessing its impact on secondary access.  

The aim of this PULSE (retrospective and multicenter) subanalysis was to evaluate the incidence of secondary access related vascular complications after transradial (TRSA) vs transfemoral (TFSA) in TAVR. 

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The primary outcome was the incidence of major and minor secondary-access-related vascular complications. These complications were classified into bleeding, stenosis/occlusion, dissection and pseudoaneurysm. 

8,851 patients were looked at, 1,686 (19%) received TRSA and 7,165 (81%) TFSA. For sample homogenization, propensity analysis was carried out, resulting in 512 patients in each group. Mean patient age was 82, and 49.1% were women. 

Secondary access vascular complications occurred in 0,3 % of TRSA patients vs. 3,2 % of TFSA patients (P < 0,001), and were considered major in 0,2 % of TRSA and 1,5 % of TFSA patients, and minor in 0,1 % and 1,7 %, respectively (P < 0,001 for both). No TRSA patient required surgical repair, while 0,9 % of TFSA patients did require intervention. 

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On the other hand, primary access vascular complications were similar between groups, with an incidence of 11,6 % in TRSA and 11,5 % in TFSA patients (P = 0,93). However, type III/IV bleeding was less frequent among TRSA patients (2,5 %) vs TFSA (4,7 %) (P < 0,001). After sample homogenization, secondary access related complication rate was 0,2 % for TRSA vs 2,9 % for TFSA (P < 0,001). 

Conclusion: Transradial (TRSA) vs. Transfemoral Approach (TFSA) in TAVR: Safer with Fewer Complications 

TAVR patients treated via femoral approach, the use of, the use of TRSA was associated with lower access-related complications rate, vs. TFSA. These findings suggest that the transradial access can be considered safe vs. the femoral, for secondary access. 

Original Title: Femoral or Radial Secondary Access in TAVR A Subanalysis from the Multicenter PULSE Registry.

Reference: David Grundmann MD et al JACC Cardiovasc Interv.2024;17:2923–2932.