Comparative Effectiveness of Balloon Aortic Valvuloplasty via Transradial and Transfemoral Access

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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: = .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.

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