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Single-Access Transfemoral TAVI with a Balloon Expandable Valve: Age-Stratified Analysis of Clinical Outcomes

Lookup NU author(s): Muntaser Omari, Dr Omran Abukhalaf, Sarah Lamb, Dr Rajiv Das, Professor Azfar ZamanORCiD, Dr Mohammad Alkhalil

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© 2026 by the authors. Background: Single-access transfemoral transcatheter aortic valve implantation (TAVI) reduces the need for multiple vascular access and therefore, the related risk of related complications. However, the impact of patient age on its clinical outcomes remains uncertain. Methods: This is a secondary analysis of previously reported propensity score matched study comparing clinical outcomes of single- versus dual-access transfemoral TAVI using SAPIEN-3-Ultra. We examined the relation between patient age, access strategy and outcomes—specifically, 30-day safety endpoint according to the Valve Academic Research Consortium 3 (VARC-3) and major adverse cardiovascular events (MACE), defined as death, permanent pacemaker, neurological or vascular complications—using logistic regression interaction analyses, and restricted cubic spline modelling. Results: A total of 204 patients (propensity score-matched cohort) were included in the study. The elderly group were more likely to have hypertension, peripheral vascular disease or stroke. The use of single access was comparable. The elderly cohort demonstrated a tendency toward longer fluoroscopy and procedural times compared with the non-elderly group. This pattern likely reflects the greater technical complexity and heightened procedural caution often associated with older patients, including more challenging vascular anatomy and the need for careful device handling. Although not statistically significant, these findings remain clinically meaningful and are consistent with the notion that procedures in elderly patients frequently require more meticulous planning and execution. There was a significant interaction between access strategy and age in reducing MACE, but not in VARC-3 safety outcomes. Single access was associated with a significant reduction in MACE (5.4% vs. 26.7%, p = 0.015) with comparable technical and safety outcomes when compared with elderly patients who underwent dual-access TAVI. Conclusions: Single-access TAVI was linked to favourable early outcomes, maintained procedural success, and suggested a possible age-dependent pattern in the occurrence of MACE. Our findings support the need for randomised studies to demonstrate superiority of single- versus dual-access TAVI, particularly in the elderly population.

Publication metadata

Author(s): Saluja S, Omari M, Abukhalaf O, Stewart D, Lamb S, Cartlidge T, Edwards R, Das R, Zaman A, Farag M, Alkhalil M

Publication type: Article

Publication status: Published

Journal: Journal of Clinical Medicine

Year: 2026

Volume: 15

Issue: 16

Online publication date: 14/08/2026

Acceptance date: 11/08/2026

Date deposited: 07/09/2026

ISSN (electronic): 2077-0383

Publisher: MDPI

URL: https://doi.org/10.3390/jcm15166305

DOI: 10.3390/jcm15166305

Data Access Statement: The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.

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