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The impact of transradial secondary access (TRSA) compared to transfemoral secondary access (TFSA) on adverse events remains uncertain. Therefore, we conducted an updated meta-analysis to compare procedural complications between TRSA and TFSA in TAVR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We systematically searched PubMed, Scopus, and the Cochrane Library for studies comparing TRSA and TFSA in patients undergoing TAVR. The primary endpoints were 30-day rates of each of the following: access-related bleeding, access-related vascular complications, stroke\/transient ischemic attack (TIA), myocardial infarction (MI), acute kidney injury (AKI stage III or higher), and all-cause mortality. Leave-one-out sensitivity analyses and subgroup analyses stratified by primary access route were performed to assess the consistency of the findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seven studies with 6327 patients were included, comprising of six observational studies and one randomized controlled trial TRSA was associated with significantly lower odds of mortality (OR 0.55, 95% CI [0.39, 0.78], p\u2009=\u20090.0007), stroke\/TIA (OR 0.58, 95% CI [0.39, 0.87], p\u2009=\u20090.009), major\/life-threatening bleeding (OR 0.50, 95% CI [0.30, 0.83], p\u2009=\u20090.008), and major vascular complications (OR 0.59, 95% CI [0.41, 0.85], p\u2009=\u20090.004). Additionally, we stratified outcomes for patients undergoing transfemoral primary access (TFPA) to determine whether the primary access route influences results. The transradial group demonstrated significantly lower odds of 30-day all-cause mortality (OR 0.49, 95% CI [0.28, 0.87], p\u2009=\u20090.01), and 30-day minor bleeding (OR 0.48, 95% CI [0.27, 0.86], p\u2009=\u20090.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Key limitations included predominance of non-randomized studies and high heterogeneity in some outcomes. In patients undergoing TAVR, TRSA is associated with significantly lower complications compared to TFSA, suggesting it may be a superior alternative.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s43044-025-00706-3","type":"journal-article","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T14:09:41Z","timestamp":1767190181000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transradial vs transfemoral secondary access outcomes in transcatheter aortic valve replacement: an updated systematic review and meta-analysis"],"prefix":"10.1186","volume":"77","author":[{"given":"Hashim","family":"Ishfaq","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reyan Hussain","family":"Shaikh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emaan","family":"Fatima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mian Muinuddin","family":"Jamshed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamza","family":"Ishfaq","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdulkareem","family":"Lukan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hina","family":"Inam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Bilal","family":"Ibrahim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hafeez","family":"Shaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,12,31]]},"reference":[{"key":"706_CR1","doi-asserted-by":"publisher","first-page":"1609","DOI":"10.1056\/NEJMoa1514616","volume":"374","author":"MB Leon","year":"2016","unstructured":"Leon MB, Smith CR, Mack MJ et al (2016) Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. 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