Transaxillary Versus Transfemoral Access for Transcatheter Aortic Valve Implantation: A Propensity Score-Matched Comparison of Clinical Outcomes Using VARC-3 Endpoints

Vollständiger Abstract

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Background/Objectives: Transaxillary access (TAx) is an established alternative to transfemoral access (TF) for transcatheter aortic valve implantation (TAVI) in patients with unfavorable iliofemoral anatomy. While TAx-TAVI has been increasingly adopted at experienced centers, propensity score-matched comparative data with VARC-3 endpoint definitions are scarce, and most existing series originate from Western European cohorts. We aimed to address this gap by reporting outcomes from a propensity-matched TAx versus TF cohort using VARC-3 endpoints, contributing contemporary data from a high-volume Turkish center with established alternative access expertise. Methods: Among 2389 consecutive TAVI procedures screened between January 2016 and December 2024, 291 patients with complete data were included. After stratification by access route (TAx n = 51; TF n = 240) and exclusion of one TAx patient with missing covariates, 1:2 greedy nearest-neighbor propensity score matching was performed using nine covariates. The final cohort comprised 150 patients (50 TAx, 100 TF). All outcomes were defined per VARC-3 criteria. Results: All nine covariates achieved standardized mean differences