Transfemoral versus transapical approach for transcatheter aortic valve implantation: Hospital outcome and risk factor analysis.

Abstract

Background: Transcatheter aortic valve implantation is indicated in high-risk patients with aortic stenosis. We compared the clinical outcome of 180 consecutive patients who underwent transapical (TA) and transfemoral (TF) procedures in a single centre. Methods: Ninety consecutive TA (TA-group) and 90 consecutive TF (TF-group) were performed from 2009 to 2014. Clinical variables were prospectively collected and retrospectively analysed for hospital outcomes and to identify risk factors for hospital mortality, vascular complications and stroke. Results: Mean age was 80±8.5 and 83±8.4years, in the TA and TF-group, respectively. TA-group presented higher prevalence of comorbidities: more vascular disease (79% vs 22%, p<0.001), chronic pulmonary disease (32% vs 10%, p<0.001), previous vascular surgery (14% vs 4%, p=0.039), coronary disease (60% vs 40%, p=0.007), and previous cardiac surgery (28% vs 17%, p=0.073). Logistic Euroscore was 36±15% in the TA-group and 25±14% in the TF-group (p<0.001), but hospital mortality was similar (TA:9%, TF:10%, p=0.799). Access-related vascular complications occurred more often in transfemoral patients (TA:3%, TF:11%, p=0.081) while major bleeding (TA:3%, TF:4%, p=1) and stroke (TA:2%, TF:3%, p=1) were equally distributed. Postoperative renal failure and dialysis were associated with impaired neurological outcome (p=0.035 and p=0.020, respectively). Mild to severe paravalvular leak was more prevalent in transfemoral patients (TA:5%, TF:25%, p<0.001). Conclusions: In our experience, the TA and TF-group presented different risk profiles but mortality rate and adverse neurological outcome had a similar incidence. The transfemoral approach carried more vascular complications and paravalvular leaks but last-generation devices will improve this outcome.