title: Transapical versus transfemoral aortic valve implantation: a comparison of survival and safety.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) is a therapeutic option for high-risk patients with aortic stenosis. Procedural mortality remains high in comparison with conventional aortic valve replacement (AVR) because patients determined for TAVI are commonly denied conventional surgery. We aimed to evaluate access-related complications between the transfemoral (TF) and the transapical (TA) approach and to compare survival between TAVI and conventional AVR in propensity-score-matched patients.
  
  
  METHODS
  Between January 2008 and November 2009, 40 patients underwent TAVI (TF, n=10; TA, n=30) with the Edwards Sapien bioprosthesis (Edwards Lifesciences, Irvine, CA). Survival and postoperative complications were evaluated between the TF and the TA approach. A comparison of survival was made between the TAVI patients and propensity-score-matched patients undergoing conventional AVR.
  
  
  RESULTS
  Successful implantation rate was 92.5% (37 of 40). Thirty-day mortality was 5.0% (2 of 40), and the overall in-hospital mortality was 10.0% (4 of 40). Survival after TAVI was 77% at both 6 months and 1 year. Major vascular complications occurred in 3 of 10 patients (all in the TF group), and 3 of 40 patients (7.5%) suffered cerebrovascular events. A comparison of survival between TAVI and propensity score-matched conventional AVR patients showed no significant difference in either the TA group (p=0.73) or the TF group (p=0.59).
  
  
  CONCLUSIONS
  The vascular complications occurring when using the TF approach were probably related to a combination of a wide introducer sheath and heavily calcified femoral arteries in a high-risk population. No serious complications were encountered when using the TA approach. After propensity-score matching, survival with both the TA and TF approaches is similar to that after AVR.
authors.affiliation: Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia and Intensive Care, Skane University Hospital and Lund University, Lund, Sweden.
authors.forename: Malin
authors.initials: M
authors.lastname: Johansson
authors.forename: Shahab
authors.initials: S
authors.lastname: Nozohoor
authors.forename: Per Ola
authors.initials: PO
authors.lastname: Kimblad
authors.forename: Jan
authors.initials: J
authors.lastname: Harnek
authors.forename: Göran K
authors.initials: GK
authors.lastname: Olivecrona
authors.forename: Johan
authors.initials: J
authors.lastname: Sjögren
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001705:Bioprosthesis; D006328:Cardiac Catheterization; D015331:Cohort Studies; D005260:Female; D005263:Femoral Artery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D018579:Patient Selection; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome