Key result
Transcervical TAVR had similar 30-day all-cause mortality compared to transapical TAVR (2.3% vs 8.5%, P=0.124), but resulted in significantly shorter procedure duration and hospital length of stay.
Why the study?
Transfemoral access is standard for TAVR, but alternative approaches are needed for some patients, prompting a comparison of clinical and echocardiographic outcomes between transapical and transcervical access.
Does the transcervical approach improve clinical and procedural outcomes compared to the transapical approach in patients undergoing TAVR for severe aortic stenosis?
Cohort (n=176)
No
Does the transcervical approach improve clinical and procedural outcomes compared to the transapical approach in patients undergoing TAVR for severe aortic stenosis?
Absolute Event Rate: 2.3% vs 8.5%
p-value: p=0.124
The transcervical approach for TAVR offers shorter procedure times and hospital stays compared to the transapical approach, with comparable 30-day mortality, making it a viable alternative when transfemoral access is contraindicated.
Transcervical TAVR may offer procedural advantages over transapical without mortality difference; leaves open need for randomized confirmation in non-transfemoral candidates.
OBJECTIVES: Transfemoral approach is the standard access-route for transcatheter aortic valve replacement (TAVR). However, alternative approaches are needed in a number of patients and accesses such as transapical (TA) TAVR or transcervical (TC) are used. We aimed to compare clinical and echocardiographic outcomes after TA-TAVR or TC-TAVR. METHODS: All patients who underwent TA- and TC-TAVR for severe aortic stenosis in our institution between 2008 and 2020 were retrospectively included. End points included 30-day all-cause mortality, procedural complications (according to the Valve Academic Research Consortium-2 criteria), procedure duration, intensive care unit (ICU) length of stay (LOS) and overall hospital LOS. For 30-day all-cause mortality, we furthermore used a Cox proportional-hazards model to adjust for significant between-group differences in baseline characteristics as well as difference in year of intervention. RESULTS: TAVR was performed in 176 patients, using a TA approach (n = 127) or a TC approach (n = 49). Baseline clinical and echocardiographic characteristics were comparable between the 2 groups, except age and peripheral artery disease. All-cause 30-day mortality rates were not significantly different (8.5% in the TA group vs 2.3% in the TC group, P = 0.124). TC approach was associated with significantly shorter procedure duration {71.0 [interquartile range (IQR) 52.5-101.0] vs 93 [IQR 80.0-120.0] min, P < 0.001}, shorter ICU LOS [0.0 (IQR 0.0-0.0) vs 1.0 (IQR 1.0-3.0) days, P < 0.001] and shorter hospital LOS [7.0 (IQR 5.0-9.5) vs 14.0 (IQR 10.0-22.0) days, P < 0.001]. CONCLUSIONS: The TC approach may be a good first-choice alternative in case of contraindications to transfemoral-TAVR.
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Lu et al. (2020) conducted a cohort in Severe aortic stenosis (n=176). Transcervical (TC) approach for TAVR vs. Transapical (TA) approach for TAVR was evaluated on 30-day all-cause mortality (p=0.124). Transcervical TAVR had similar 30-day all-cause mortality compared to transapical TAVR (2.3% vs 8.5%, P=0.124), but resulted in significantly shorter procedure duration and hospital length of stay.
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