Transapical and Transaortic TAVR: Valid Alternatives to the Transfemoral

Courtesy of Dr. Carlos Fava.

The femoral approach has been the gold standard for the transcatheter aortic valve replacement procedure (TAVR); however, it is anatomically unsuitable for an important number of patients, and these require a different approach. At present, there is little evidence in support of the transapical or transaortic access sites as valid alternatives to the transfemoral.

This study included 467 transfemoral, 289 transaortic and 42 transapical TAVR procedures.

Mean age was 83, and the presence of atrial fibrillation was higher in the transfemoral and transapical TAVR groups. On the other hand, vascular peripheral disease was more frequent among transapical and transaortic TAVR patients. STS was similar, but EuroSCORE resulted higher in the transapical group.

Procedural success was similar, but those undergoing transapical and transaortic TAVR presented more post procedural kidney failure.

Researchers also observed a trend towards lower periprocedural mortality in those undergoing transfemoral TAVR.

At one year follow up, there were no differences in mortality, with a trend in favor of the transfemoral approach. As regards transapical vs. transaortic, the trend was in favor of the transaortic access site.

Conclusion

At 30 days and one year, mortality resulted similar with all three access sites, with a trend in favor of the transfemoral approach. Moreover, the transaortic approach may be an alternative to the transapical when the transfemoral approach is not viable.

Editorial Comment

The gold standard access site continues to be the transfemoral; however, due to the exponential increase of TAVR procedures, a growing number of patients call for different alternatives.

Courtesy of Dr. Carlos Fava. Favaloro Foundation, Buenos Aires, Argentina. 

Original Title: Direct Comparison of Feasibility and Safety of Transfemoral versus Transaortic versus Transapical transcatheter Aortic Valve Replacement.

Reference: Takahide Arai, et al J Am Coll cardiol Interv 2016;9:2320-5.

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