title: Direct Comparison of Feasibility and Safety of Transfemoral Versus Transaortic Versus Transapical Transcatheter Aortic Valve Replacement.
abstract: The aim of this study was to compare outcomes among transfemoral (TF), transaortic (TAo), and transapical (TA) transcatheter aortic valve replacement (TAVR).
  
  
  
  Very few studies have investigated the differences among TF, TAo, and TA TAVR in terms of safety and feasibility.
  
  
  
  Between January 2011 and December 2014, 467 consecutive cases of TF TAVR, 289 cases of TAo TAVR, and 42 cases of TA TAVR were analyzed. Baseline characteristics, procedural characteristics, and outcomes were compared between TF and TAo and between TAo and TA approaches.
  
  
  
  Balloon-expandable prostheses were used in 320 cases of TF TAVR (69%), 209 cases of TAo TAVR (72%), and all cases of TA TAVR. The remaining cases were performed using self-expandable prostheses. Patient age and Society of Thoracic Surgeons score were similar (83.8 years vs. 83.7 years vs. 81.3 years and 6.2% vs. 5.8% vs. 7.1%) among all groups. Although nonsignificant, a trend toward lower 30-day mortality (5% vs. 9%; p = 0.057) was observed with TF TAVR compared with TAo TAVR. Kaplan-Meier analysis revealed a trend toward a higher 1-year survival rate (log-rank p = 0.067) with TF TAVR compared with TAo TAVR. There was no significant difference in 30-day mortality between TAo and TA TAVR (9% vs. 14%; p = 0.283). Kaplan-Meier analysis revealed a trend toward a higher 1-year survival rate (log-rank p = 0.154) with TAo TAVR compared with TA TAVR.
  
  
  
  Although the 30-day mortality and 1-year survival rates were similar between TF and TAo TAVR patients, a trend in favor of the TF approach was observed. In addition, the TAo approach can be considered as an alternative to the TA approach when the TF approach seems unsuitable.
authors.affiliation: Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Takahide
authors.initials: T
authors.lastname: Arai
authors.affiliation: Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Mauro
authors.initials: M
authors.lastname: Romano
authors.affiliation: Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France. Electronic address: t.lefevre@angio-icps.com.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefèvre
authors.affiliation: Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hovasse
authors.affiliation: Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Farge
authors.affiliation: Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Le Houerou
authors.affiliation: Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashida
authors.affiliation: Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France; Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Garot
authors.affiliation: Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Hakim
authors.initials: H
authors.lastname: Benamer
authors.affiliation: Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Unterseeh
authors.affiliation: Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Erik
authors.initials: E
authors.lastname: Bouvier
authors.affiliation: Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.affiliation: Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Chevalier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D063126:Balloon Valvuloplasty; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016208:Databases, Factual; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery; D006350:Heart Valve Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome
keywords: severe symptomatic aortic stenosis; transaortic; transapical; transcatheter aortic valve replacement; transfemoral