Transapical TAVR had fewer vascular complications (0% vs 9%, p=0.003) and less mild-moderate paravalvular regurgitation (24.2% vs 43.5%, p=0.006) compared to the transfemoral approach.
Cohort (n=200)
Does transapical transcatheter aortic valve replacement reduce complications compared to the transfemoral approach in patients with severe aortic valve stenosis?
Beyond the learning curve, transapical TAVR was associated with fewer vascular complications and less paravalvular regurgitation compared to transfemoral TAVR, with similar operative mortality.
Absolute Event Rate: 49% vs 43%
p-value: p=0.478
BACKGROUND: Most studies comparing transapical and transfemoral transcatheter aortic valve replacement include the center's early operative experience, which may negatively impact the outcomes. This study reports our experience beyond the learning curve with transapical and transfemoral transcatheter aortic valve replacement. METHODS: A total of 303 patients underwent transcatheter aortic valve replacement from November 2008 through August 2013. There were 153 patients (50.5%) who received transfemoral valve replacement, 130 (42.9%) received transapical valve replacement, and 20 (6.6%) received transaortic valve replacement. We retrospectively reviewed the outcomes of the most recent 100 consecutive patients each from the transfemoral and transapical valve replacement groups. RESULTS: The median age was 82 years (range, 54 to 95) and 110 patients (55%) were male; STS predicted risk of mortality was 8.1% (0.7 to 27.8) and was similar between groups (p = 0.256). Operative complications occurred in 49 patients (49%) in the transapical replacement group and in 43 (43%) in the transfemoral group (p = 0.478). Vascular complications occurred only in the transfemoral group and included nine patients (9%; p = 0.003). Paravalvular regurgitation at discharge of grade mild-moderate occurred in 23 patients (24.2%) in the transapical group in comparison to 40 (43.5%) in the transfemoral group (p = 0.006). Operative mortality occurred in two patients (2%) in the transapical group and in five (5%) in the transfemoral group (p = 0.445). CONCLUSIONS: Transapical transcatheter aortic valve replacement is associated with less prevalence of vascular complications and mild-moderate paravalvular regurgitation in comparison to the transfemoral approach. Further study is necessary to determine if the transapical technique is the preferred option. doi: 10.1111/jocs.12323 (J Card Surg 2014;29:303-307).
Greason et al. (Fri,) conducted a cohort in Severe Aortic Valve Stenosis (n=200). Transapical transcatheter aortic valve replacement vs. Transfemoral transcatheter aortic valve replacement was evaluated on Operative complications (p=0.478). Transapical TAVR had fewer vascular complications (0% vs 9%, p=0.003) and less mild-moderate paravalvular regurgitation (24.2% vs 43.5%, p=0.006) compared to the transfemoral approach.
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