Safety and efficacy of intravascular lithotripsy-facilitated transcatheter aortic valve replacement: a systematic review and meta-analysis
S Chamay, C Y Asselin, D Chekhava, M Dandamudi, M Naguib, P Genereux, J Brown III, L Gillam, P Villablanca, A Jabri, G GiustinoAbstract
Background/Introduction
Intravascular lithotripsy (IVL) can be utilized to increase vessel compliance and diameter and allow for safe transfemoral access during transcatheter aortic valve replacement (TAVR).
Purpose
The aim of our study is to systematically evaluate the safety and efficacy of IVL-facilitated transfemoral access in patients undergoing TAVR implantation.
Methods
A systematic review and meta-analysis was conducted for studies including patients with severe aortic stenosis undergoing TAVR implantation with IVL-facilitated femoral access from inception through December 2025. The primary outcomes of interest included 30-day mortality, successful IVL-facilitated transfemoral access, and successful TAVR implantation. Secondary outcomes included perforation, dissection, pseudoaneurysm, need for covered stent, major vascular complication, stroke, and acute kidney injury. Proportion-based meta-analyses were conducted using random-effects models in R.
Results
Nine studies encompassing 546 patients with IVL-facilitated TAVR were included in our analysis. The mean age was 80 years with 59% males and a median STS score of 3.9. The pooled 30-day all-cause mortality rate was 2.3% (95% CI 1.01-5.27; I2 0%). Successful IVL-facilitated transfemoral access was 95.2% (95% CI 84.4-100; I2 82%) and successful TAVR implantation was achieved in 100% of patients (95% CI 99-100; I2 0%). Rates of vessel perforation (0%), dissection (4.5%), pseudoaneurysm (3.9%), need for covered stent (5.6%), major vascular complication (5%), stroke (0.1%), and acute kidney injury (4.4%) were low. The primary outcomes are depicted further in Figure 1.
Conclusion(s)
IVL-facilitated transfemoral access during TAVR is associated with low 30-day all-cause mortality and high procedural success. Major procedural complications were infrequent. Larger prospective studies are warranted to further define patient selection and optimize outcomes.figure--1--primary--outcomes.pngFor image description, please refer to the figure legend and surrounding text.