Transapical and transfemoral aortic valve implantation: Operative outcome in 180 consecutive patients

Abstract

Objectives The new Transcatheter Aortic Valve Replacement (TAVR) represents a valid alternative to the standard surgical approach for the treatement of aortic stenosis in patients with prohibitive surgical risk, and at the moment, the two main access routes employed are transapical and transfemoral TAVR. Aim of the study is to compare the outcome of 180 consecutive patients who underwent transapical and transfemoral aortic valve procedures. Method From 2008 to 2014, 180 consecutive patients underwent transapical (90 patients) or transfemoral (90 patients) TAVR procedures at our institute. Preoperative, intraoperative and postoperative variables were retrospectively collected and analysed to identify risk factors for mortality, vascular and neurological complications. Surgical outcomes were compared. Results Mean age was 80±8.5 years and 83±8.4 years, in the TA and TF group, respectively. TA- TAVR group presented a higher prevalence of comorbidities with more peripheral vascular disease, COPD, previous vascular surgery, coronary disease, previous coronary surgery and previous cardiac surgery. The logistic Euroscore I was 36±15% in the TA group and 25±14% in the TF group (p<0.001). Hospital mortality was similar (TA: 9%, TF: 10%, p=0.799) and early extubation seems to be a protective factor against hospital mortality (p=0.001). Access related vascular complications occurred more often in TF (TA: 3%, TF: 11%, p=0.081) whereas major or life threatening bleeding (TA: 3%, TF: 4%, p=1) and major stroke (TA: 2%, TF: 3%, p=1) were equally distributed. Postoperative acute renal failure and the need for a postoperative dialysis was associated with impaired neurological outcome (respectively p=0.035 and p=0.020). Paravalvular leaks (degree 2-4) were more prevalent in TF patients (TA: 6%, TF: 26%, p<0.001). Conclusion The TF and the TA TAVR groups include two different patients' risk profiles (the TA being at higher risk) but mortality rate and adverse neurological outcome have a similar incidence. The transfemoral approach carries a higher risk of vascular complications and paravalulvar leaks (degree 2 or greater)