Comparison of 30-Day Outcomes of Transfemoral Versus Transapical Approach for Transcatheter Aortic Valve Replacement: A Single-Center US Experience

Shishir Murarka, Mohamad Lazkani, Michael Neihaus, May Boggess, Michael Morris, George Gellert, H Kenith Fang, Ashish Pershad
Annals of Thoracic Surgery 2015, 99 (5): 1539-44

BACKGROUND: The optimal access route for transcatheter aortic valve replacement (TAVR) remains debatable. We compared early safety outcomes at 30 days between the transfemoral (TF) and transapical (TA) approaches in a single, high-volume center in the United States.

METHODS: Data were collected retrospectively on consecutive patients who underwent TAVR by the TF or TA approach. The primary endpoints included the following: all-cause mortality; stroke; major and life threatening bleeding; renal failure; valve-related dysfunction requiring an intervention; and moderate to severe paravalvular leak and major vascular complications at 30 days. The secondary endpoints included need for a pacemaker and hospital length of stay.

RESULTS: A total of 123 well-matched patients underwent TAVR (TF 66 [54%] and TA 57 [46%]). All-cause mortality at 30 days was identical in both groups (TF 4.5% vs TA 5.3%, p = 0.999). The rates of myocardial infarction (TF 1.6% vs TA 1.5%, p = 0.999) and stroke (TF 3.0% vs TA 5.3%, p = 0.662) were similar. Major bleeding, acute renal failure, valve-related dysfunction, paravalvular leak, and mean hospital length of stay were also similar in both groups. Unplanned vascular complications, fluoroscopy time, and contrast utilization were significantly lower in the TA group.

CONCLUSIONS: The TA approach has similar early safety outcomes when compared with the TF approach. The TA approach is more procedurally efficient when compared with the TF approach.

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