Safety and efficacy of single versus dual arterial access in transfemoral transcatheter aortic valve implantation: a systematic review and meta-analysis of propensity-matched cohort

Transfemoral transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis (AS). Although dual arterial access (DAA) is commonly used for catheter control and haemodynamic monitoring, single arterial access (SAA) has emerged as a minimalist strategy aimed at reducing procedural complexity and access-site complications. However, comparative outcome data remain limited. Four propensity score-matched observational studies comprising 540 patients (50.4% SAA) were included. Compared with DAA, SAA was associated with a significantly lower risk of total vascular complications (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.17–0.67; p < 0.001), largely driven by reductions in minor access-site events (OR 0.44, 95% CI 0.20–0.95; p = 0.04), while rates of major vascular complications were similar between groups. There were no significant differences in all-cause mortality, stroke or transient ischaemic attack, paravalvular leak, or major bleeding. SAA was also associated with shorter procedural time (mean difference [MD] -17.1 min, 95% CI -32.8, -1.4; p = 0.03) and lower contrast volume use (MD -28.6 mL, 95% CI -55.3, -1.9; p = 0.04), although substantial heterogeneity was observed. In patients with symptomatic severe AS undergoing transfemoral TAVI, SAA appears to be a safe and feasible alternative to DAA and is associated with fewer vascular complications without compromising major clinical outcomes. Future prospective and randomised studies incorporating procedural complexity and device-specific outcomes are needed to confirm these results and better define optimal patient selection.