Transcatheter aortic valve implantation: The transfemoral versus the transapical approach.

Transcatheter aortic valve implantation (TAVI) is emerging as a viable alternative to conventional surgical aortic valve replacement in high risk and surgically inoperable patients who have severe symptomatic aortic stenosis. A comprehensive review of this new technology has recently been published as an “expert consensus document” (1). This document, however, did not address the relative merits of the transapical versus the transfemoral approach to TAVI. The chosen approach is largely dictated by the quality and adequacy of the aortoiliac and femoral arteries and whether the vessels can support large catheter access. The relative merits of the transfemoral and transapical approaches continue to evolve. In this article, we aim to review the published results of TAVI in high risk or inoperable patients with severe aortic stenosis with an emphasis on comparing the outcomes between the transapical versus transfemoral techniques. It is estimated that TAVI has been employed in more than forty thousand patients worldwide and there is published data on over five thousand patients (1). Although most of this information has been obtained from registries and other observational studies, there is one prospective, multicenter, randomized study of the clinical outcomes after insertion of the Edwards SAPIEN transcatheter valve (2-5). This trial, called Placement of Aortic Transcatheter Valves (PARTNER), included two populations of patients with severe, symptomatic aortic stenosis: Cohort A, deemed at high risk for conventional surgery and Cohort B, considered surgically inoperable.