Transapical and Transfemoral Aortic Valve Implantation. Impact and General Considerations of both Approaches

pp. 171-176

Abstract

Background: Transcatheter aortic valve implantation (TAVI) has emerged as a therapeutic option in inoperable or high surgical risk patients with severe symptomatic aortic stenosis. The transapical approach is an alternative access for patients with contraindications for the transfemoral access.

Objective: The aim of this study was to evaluate the feasibility and reproducibility of transapical TAVI and compare the short and mid-term outcome with that of transfemoral TAVI.

Methods: A cohort of 80 patients undergoing transapical (n=24) and transfemoral (n=56) TAVI was retrospectively evaluated. Procedure-related complications as defined by VARC-2 criteria, and short-term and mid-term mortality were analyzed and compared in both groups.

Results: Patients in the transapical group were older (83.6 ± 5 vs. 80.0 ± 8.3; p = 0.04) and had greater prevalence of coronary artery disease (75 vs. 44%; p = 0.04) and peripheral vascular disease (37% vs. 16%; p = 0.01). Patients in the transapical group had lower fluoroscopy time (14.9 minutes ± 5.8 vs. 22.9 minutes ± 8.7; p = 0.001) and presented a non-significant trend toward greater requirement of dialysis after the procedure (12.5% vs. 1.8%, p = 0.13). Hospital stay was longer in the transapical group (13.6 ± 23 days vs. 7-2 ± 6.9 days, p = 0.05). Mortality at 30 days and one year was greater in the transapical group (20.8% vs. 5.4%; p = 0.03 and 25% vs. 8.9%; p = 0.04), respectively.

Conclusions: In our experience, transapical TAVI is a feasible and reproducible procedure for patients with severe symptomatic aortic stenosis unsuitable for transfemoral approach. Transapical access was associated with increased risk of mortality at 30 days, in agreement with several publications.