Clinical Outcomes After Transapical and Transfemoral Transcatheter Aortic Valve Insertion: An Evolving Experience.
BACKGROUND
Prior publications note increased adverse events after transapical compared with transfemoral access transcatheter aortic valve insertion (TAVI). We reviewed our TAVI experience to understand the differences in baseline patient characteristics and outcomes associated with the two access methods.


METHODS
The records were reviewed of 567 patients who underwent transfemoral (n = 351, 61.9%) and transapical (n = 216, 38.1%) TAVI from November 2008 through July 2015.


RESULTS
Compared with patients who underwent transfemoral access, the patients who underwent transapical access were older (82.0 ± 7.5 versus 79.6 ± 9.7 years; p = 0.006), had more peripheral vascular disease (78.2% versus 54.7%; p < 0.001), more previous coronary artery bypass graft operations (50.9% versus 32.5%; p < 0.001), and higher Society of Thoracic Surgeons predicted risk of mortality (9.4% ± 5.4% versus 8.8% ± 6.5%; p = 0.032). In-hospital and 30-day mortality rates, however, were similar between the two groups (transapical, n = 7, 3.2%; transfemoral, n = 13, 3.7%; p = 0.772). Follow-up echocardiography in 547 (100.0%) surviving patients at a median of 182 days (interquartile range, 35 to 420) demonstrated less paravalvular regurgitation grade of moderate or greater in patients who underwent transapical access (transapical, n = 6, 2.9%; transfemoral, n = 35, 10.4%; p = 0.001) but similar ejection fraction in the two groups (transapical, 55.4% ± 12.2%; transfemoral, 55.9% ± 13.0%; p = 0.419). Mortality rates at 1 year (transapical, 19.2% ± 3.0%; transfemoral,14.7% ± 3.2%) and 4 years (transapical, 47.4% ± 6.4%; transfemoral, 42.7% ± 4.9%) were also similar between the two groups (p = 0.342).


CONCLUSIONS
Transapical and transfemoral transcatheter aortic valve insertions result in similar operative and longer term mortality rates, despite differences in baseline patient risk. The findings support the concept that access does not influence treatment-related mortality rates.
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Takashi
T
Murashita
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: greason.kevin@mayo.edu.
Kevin L
KL
Greason
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Alberto
A
Pochettino
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Gurpreet S
GS
Sandhu
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Vuyisile T
VT
Nkomo
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
John F
JF
Bresnahan
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Guy S
GS
Reeder
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
David R
DR
Holmes
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Charanjit S
CS
Rihal
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Department of Radiology, Mayo Clinic, Rochester, Minnesota.
Verghese
V
Mathew
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005263:Femoral Artery; D006350:Heart Valve Prosthesis; D006801:Humans; D015994:Incidence; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome