title: Outcomes after transcatheter aortic valve implantation: transfemoral versus transapical approach.
abstract: 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/m(2), p < 001) and left atrial volume reduction (48 ± 17 vs 34 ± 14 mL/m(2), 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.
authors.affiliation: Department of Cardiology and Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: See Hooi
authors.initials: SH
authors.lastname: Ewe
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.forename: Arnold C T
authors.initials: AC
authors.lastname: Ng
authors.forename: M Louisa
authors.initials: ML
authors.lastname: Antoni
authors.forename: Frank
authors.initials: F
authors.lastname: van der Kley
authors.forename: Nina Ajmone
authors.initials: NA
authors.lastname: Marsan
authors.forename: Arend
authors.initials: A
authors.lastname: de Weger
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tavilla
authors.forename: Eduard R
authors.initials: ER
authors.lastname: Holman
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D020517:Atrial Appendage; D006328:Cardiac Catheterization / Q000379:methods*; D002406:Catheterization, Peripheral / Q000379:methods*; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome