Comparative Effectiveness of Balloon Aortic Valvuloplasty via Transradial and Transfemoral Access
Recommended Citation
Fang JX, Villablanca P, Frisoli TM, Engel Gonzalez P, Lee JC, Fram GK, Lai L, Giustino G, Alrayes H, Kamel-Abusalha L, Ellauzi R, Gregerson S, Chiang M, So C, Wang D, O'Neill W, O’Neill BP. Comparative Effectiveness of Balloon Aortic Valvuloplasty via Transradial and Transfemoral Access. J Soc Cardiovasc Angiogr Interv 2025; 4(12):104015-104015.
Document Type
Article
Publication Date
12-1-2025
Publication Title
J Soc Cardiovasc Angiogr Interv
Keywords
balloon aortic valvuloplasty; radial access; severe aortic stenosis
Abstract
BACKGROUND: Balloon aortic valvuloplasty (BAV) is commonly performed as a bridge to therapy, for stratification, or as a palliative procedure in cases of severe aortic stenosis. The complication rate of transfemoral access BAV (transfemoral valvuloplasty [TFV]) is comparable to that of transcatheter aortic valve replacement. Transradial access BAV (transradial valvuloplasty [TRV]) is technically feasible; however, comparative data for TFV are lacking. We aim to compare TFV and TRV in terms of technical and hemodynamic success, periprocedural safety, and short-term clinical outcomes.
METHODS: Consecutive patients undergoing BAV at a tertiary center from 2021 to 2024 were assessed. TRV was performed with ultrasound guidance and an 8F short sheath equipped with compatible balloons. Hemodynamic success was defined as a reduction in gradient of 30% or more. The primary outcome was the periprocedural composite of a Valve Academic Research Consortium (VARC) 3 major vascular complication, grade 3 to 4 bleeding, and balloon entrapment, and nonaccess-related events, including complete heart block, periprocedural stroke, hypotension, severe aortic insufficiency, and periprocedural death. The secondary outcome was the 30-day composite of all-cause mortality, cardiac-related hospitalization, and discharge failure. Inverse probability of treatment weighting, followed by multivariate regression, was employed to address confounders.
RESULTS: 105 TRV and 148 TFV were included. Technical success rate was 96.2% for TRV and 98.7% for TFV (P = .21). The primary outcome event rate was significantly lower in the TRV compared to the TFV group: 2.53% vs 17.47%; adjusted odds ratio, 0.13; 95% CI, 0.04-0.49; P = .003. Technical and hemodynamic success and secondary outcomes were comparable between TRV and TFV.
CONCLUSIONS: In comparison to TFV, TRV is associated with lower rates of periprocedural safety events while maintaining similar short-term clinical outcomes and hemodynamic performance.
PubMed ID
41497994
Volume
4
Issue
12
First Page
104015
Last Page
104015
