Key result
Subclavian and transapical TAVI approaches showed no significant difference in long-term mortality up to 8 years (p=0.77), though transapical access had lower 12-month mortality (p=0.03).
Why the study?
Subclavian and transapical approaches are the primary alternatives to femoral delivery for TAVI, but their associated complications, morbidity, and long-term mortality had not been compared.
Does the subclavian approach compared to the transapical approach improve complications and long-term survival in patients undergoing non-femoral TAVI?
Cohort (n=1,506)
Yes
Does the subclavian approach compared to the transapical approach improve complications and long-term survival in patients undergoing non-femoral TAVI?
Both subclavian and transapical approaches offer safe non-femoral access for TAVI with comparable long-term survival up to 8 years, despite higher 12-month mortality and pacemaker rates with the subclavian approach.
Comparable long-term mortality should not yet change nonfemoral TAVI access selection; leaves open randomized comparisons of subclavian versus transapical approaches.
OBJECTIVES: Subclavian (SC) and transapical (TA) approaches are the main alternatives to the default femoral delivery for transcatheter aortic valve implantation (TAVI). The aim of this study was to compare complications and morbidity/mortality associated with SC and TA in a long-term time frame. METHODS: From January 2007 to July 2015, 1506 patients underwent TAVI surgery in 36 United Kingdom TAVI centers. Primary outcomes were complications according to VARC-2 criteria. The secondary outcome was long-term survival. RESULTS: The enrolled patients were distributed as follows: 1216 in the TA group and 290 in the SC group. There were no differences in the rates of acute myocardial infarction, emergency valve-in-valve, paravalvular leak, balloon post dilatation, cardiac tamponade, stroke, renal replacement therapy, vascular injuries, and 30-day mortality among the groups. Conversely, the rate of permanent pacemaker implantation (p = .02), the procedural time duration (p = .04), and the 12-month mortality (p = .03) was higher in SC than in TA, while in-hospital length of stay was reduced in SC than in TA (p = .01). Up to 8 years, the long-term mortality was not different among groups (p = .77), and no difference in long-term survival between self- versus balloon-expandable devices was found (p = .26). CONCLUSIONS: According to our results, TA provided the best 12-month survival compared to SC, while the long-term survival up to 2900 days is not significantly different between groups, so SC and TA may both represent a safe non-femoral access if femoral is precluded.
No takes yet. Share an insight, caveat, or question.
D׳Auria et al. (2022) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=1,506). Subclavian (SC) approach vs. Transapical (TA) approach was evaluated on Complications according to VARC-2 criteria. Subclavian and transapical TAVI approaches showed no significant difference in long-term mortality up to 8 years (p=0.77), though transapical access had lower 12-month mortality (p=0.03).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: