What does this research mean for the field?

Transapical TAVR is associated with a higher in-hospital mortality rate of 5.9% compared to 3.1% for transfemoral TAVR in patients with peripheral artery disease. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

February 8, 2026

Transfemoral and transapical transcatheter aortic valve replacement for patients with aortic valve stenosis and peripheral artery disease in a German comparison

Key Result

Transapical TAVR in patients with peripheral artery disease had higher in-hospital mortality (5.9% vs 3.1%, RR=1.70) and complications than transfemoral TAVR.

Key Points

This research aims to compare outcomes of transfemoral and transapical transcatheter aortic valve replacement (TAVR) in patients with aortic valve stenosis and peripheral artery disease.
Analysis of 8,934 TAVR patients in Germany from 2019 to 2022
Comparison of transfemoral and transapical procedures
Assessment of in-hospital complications and outcomes
Transapical TAVR had higher in-hospital mortality (5.9% vs 3.1%)
Major bleeding was observed more frequently in transapical TAVR (7.0% vs 3.0%)
Hospital stays were longer for transapical patients (16.4 days vs 12.0 days)
Permanent pacemaker implantation was lower in transapical TAVR (9.0% vs 13.0%)
The use of transapical procedures declined significantly from 2019 to 2022.

Structured PICO

Does transapical TAVR compared to transfemoral TAVR increase in-hospital mortality and complications in patients with aortic valve stenosis and peripheral artery disease?

Population

8,934 patients with aortic valve stenosis and peripheral artery disease hospitalized in Germany between 2019 and 2022

Intervention

Transapical transcatheter aortic valve replacement (TAVR) (n=1,515)

Comparator

Transfemoral transcatheter aortic valve replacement (TAVR) (n=7,419)

Outcome

In-hospital mortalityhard clinical

Transfemoral TAVR remains the preferred access route over transapical TAVR even in patients with peripheral artery disease due to lower in-hospital mortality and fewer complications.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background Transcatheter aortic valve replacement (TAVR) is often performed via an alternative access route in patients with severe peripheral artery disease. However, the option of a transapical access showed more complications with an overall worse outcome. Purpose Since there is no evidence of outcome based on a large number of TAVR patients with peripheral artery disease, we investigate this population using data throughout Germany. Methods We investigate 8,934 TAVR patients suffering from aortic valve stenosis as well as peripheral artery disease who were hospitalized in Germany between 2019 and 2022. Results During this time period there were 7,419 transfemoral and 1,515 transapical TAVR interventions. Patients who received a transapical TAVR were younger at 78.8 vs 80.5 years (p0.001) and had a comparable logistic EuroSCORE at 21.7 and 21.6% (p=0.635). More women were treated with a transfemoral TAVR at 37.5% vs 34.6% (p=0.031). In transapical TAVR, there were higher rates of in-hospital mortality at 5.9 vs 3.1% (p0.001), major bleeding at 7.0 vs 3.0 % (p0.001), acute kidney injury at 15.8 vs 13.5% (p=0.020), postoperative delirium at 16.8 vs 9.1% (p0.001), mechanical ventilation 48h at 6.5 vs 2.5% (p0.001), and pericardial tamponade at 2.2 vs 0.7% (p0.001). There was a longer hospital stay of 16.4 vs 12.0 days (p0.001). Transapical TAVR patients had a lower permanent pacemaker implantation rate at 9.0 vs 13.0% (p0.001). This was also reflected in the causal risk ratio (RR), which was higher for transapical TAVR in terms of in-hospital mortality (RR=1.70, p0.001), pericardial tamponade (RR=3.04, p0.001), major bleeding (RR=2.23, p0.001), mechanical ventilation 48h (RR=2.05, p0.001), and postoperative delirium (RR=1.89, p0.001). Again, the risk of permanent pacemaker implantations was lower in transapical TAVR patients (RR=0.70, p=0.010). Regarding the time course, transfemoral TAVR increased from 1,731 patients in 2019 to 2,065 in 2022, while transapical TAVR decreased from 566 to 143. Conclusion Transapical TAVR used for patients with peripheral artery disease is associated with a higher in-hospital mortality as well as overall complications. The preferred role of transfemoral over transapical TAVR even in patients with peripheral artery disease is also reflected in the declining number of transapical TAVR over time.

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