Outcomes after transcatheter aortic valve implantation: transfemoral versus transapical approach

Abstract

Background: Transcatheter aortic valve implantation is commonly implanted through a transfemoral (TFA) or transapical approach (TAA) for patients with severe aortic stenosis. This study aimed to describe the clinical and echocardiographic outcomes of TFA versus TAA.

Methods: Clinical and echocardiographic evaluations were performed at baseline, post-TAVI (transcatheter aortic valve implantation), at 6 and 12 months follow-up in 107 consecutive patients who underwent TAVI with balloon-expandable valves.

Results: The TFA was performed in 44% and the remaining patients underwent TAA. Although procedural complications were not significantly different in both approaches, more vascular complications were observed in the TFA group (18% vs 5%, p = 0.053). Patients with TAA required shorter fluoroscopy time (median 5 vs 12 min, p < 0.001), less contrast volume (median 80 vs 173 mL, p < 0.001), and similar length of hospitalization, as compared with TFA. Importantly, the early 30-day mortality (TFA: 11.1% vs TAA: 8.5%, p = 0.74) were not significantly different between the 2 approaches. Midterm survival at 6 months and 1 year was comparable between TFA and TAA (6 months: 88.9% vs 85.7% and 1 year: 80.2% vs 85.7%). All patients achieved immediate and sustained improvements in transvalvular hemodynamics, together with significant left ventricular mass regression (137 ± 39 vs 113 ± 30 g/m(2), p < 001) and left atrial volume reduction (48 ± 17 vs 34 ± 14 mL/m(2), p < 0.001) at 6 months or less.

Conclusions: Early, midterm, clinical, and echocardiographic outcomes were comparable in both approaches. However, TAA has the additional benefit of reducing radiation exposure and contrast use intraoperatively without prolonging the length of hospital stay.