Outcomes After Transcatheter Aortic Valve Implantation: Transfemoral Versus Transapical Approach

• Published in: The Annals of thoracic surgery Vol. 92; no. 4; pp. 1244 - 1251
• Main Authors: Ewe, See Hooi, MBBS, Delgado, Victoria, MD, PhD, Ng, Arnold C.T., MBBS, Antoni, M. Louisa, MD, van der Kley, Frank, MD, Marsan, Nina Ajmone, MD, de Weger, Arend, MD, Tavilla, Giuseppe, MD, PhD, Holman, Eduard R., MD, PhD, Schalij, Martin J., MD, PhD, Bax, Jeroen J., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2011; Elsevier
• Subjects: Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aorta; Aortic valve; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Atrial Appendage; Biological and medical sciences; Cardiac Catheterization - methods; Cardiology. Vascular system; Cardiothoracic Surgery; Catheterization, Peripheral - methods; Echocardiography, Doppler, Color; Echocardiography, Transesophageal; Female; Femoral Artery; fluoroscopy; Follow-Up Studies; Heart; Heart Valve Prosthesis Implantation - methods; Hemodynamics; Hospitals; Humans; Male; Medical sciences; Mortality; Pneumology; Retrospective Studies; Stenosis; Surgery; Survival; Thorax; Treatment Outcome; Ventricle; 35; Prognosis; Anesthesia; Implantation; Surgical approach; Circulatory system; Cardiology; Aortic valve; Comparative study
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2011.01.059

Background Transcatheter aortic valve implantation is commonly implanted through a transfemoral (TFA) or transapical approach (TAA) for patients with severe aortic stenosis. This study aimed to describe the clinical and echocardiographic outcomes of TFA versus TAA. Methods Clinical and echocardiographic evaluations were performed at baseline, post-TAVI (transcatheter aortic valve implantation), at 6 and 12 months follow-up in 107 consecutive patients who underwent TAVI with balloon-expandable valves. Results The TFA was performed in 44% and the remaining patients underwent TAA. Although procedural complications were not significantly different in both approaches, more vascular complications were observed in the TFA group (18% vs 5%, p = 0.053). Patients with TAA required shorter fluoroscopy time (median 5 vs 12 min, p < 0.001), less contrast volume (median 80 vs 173 mL, p < 0.001), and similar length of hospitalization, as compared with TFA. Importantly, the early 30-day mortality (TFA: 11.1% vs TAA: 8.5%, p = 0.74) were not significantly different between the 2 approaches. Midterm survival at 6 months and 1 year was comparable between TFA and TAA (6 months: 88.9% vs 85.7% and 1 year: 80.2% vs 85.7%). All patients achieved immediate and sustained improvements in transvalvular hemodynamics, together with significant left ventricular mass regression (137 ± 39 vs 113 ± 30 g/m2 , p < 001) and left atrial volume reduction (48 ± 17 vs 34 ± 14 mL/m2 , p < 0.001) at 6 months or less. Conclusions Early, midterm, clinical, and echocardiographic outcomes were comparable in both approaches. However, TAA has the additional benefit of reducing radiation exposure and contrast use intraoperatively without prolonging the length of hospital stay.