Key result
Transcervical TAVR was associated with similar 30-day mortality compared to transfemoral TAVR (HR 0.87; 95% CI 0.77-9.77; p=0.909), despite a higher baseline cardiovascular disease burden.
Why the study?
While the transfemoral approach is the gold-standard access route for TAVR, alternative approaches like the transcervical approach are needed in some patients, motivating a direct comparison between the two routes.
Does the transcervical approach yield similar outcomes to the transfemoral approach in patients undergoing transcatheter aortic valve replacement?
Cohort (n=306)
No
Does the transcervical approach yield similar outcomes to the transfemoral approach in patients undergoing transcatheter aortic valve replacement?
The transcervical approach for TAVR yields similar 30-day mortality and procedural outcomes compared to the transfemoral approach, suggesting it is a safe alternative when transfemoral access is contraindicated.
OBJECTIVES: The transfemoral (TF) approach is the gold-standard access route for transcatheter aortic valve replacement (TAVR). Alternative approaches, among which the transcervical (TC) approach, are needed in some patients. We aimed to compare TC-TAVR with TF-TAVR. METHODS: All patients who underwent TAVR in our institution between 2016 and 2020, using Edwards SAPIEN family balloon-expandable transcatheter heart valves, were retrospectively included. Endpoints included 30-day all-cause mortality, procedural complications (according to the VARC-2 criteria), procedure duration, hospital length of stay (LOS) and echocardiographic outcomes. 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 anesthesia modality. RESULTS: TAVR was performed in 306 patients, using a TF approach (n = 255) or a TC approach (n = 51). TC-TAVR was associated with significantly higher STS scores (4.06 [IQR (interquartile range), 2.05, 5.56] vs. 2.97 [IQR, 2.08, 4.88], p < 0.001) and higher prevalence of peripheral artery disease, history of stroke, previous cardiovascular surgery. 30-day mortality (hazard ratio, 0.87 [0.77, 9.77], p = 0.909) and stroke rates (2.0% vs. 1.6%, p = 0.840) were similar, as well as procedural duration (74.0 [53.0, 99.5] vs. 77.0 [58.0, 98.0] minutes, p = 0.370), LOS (6.0 [IQR, 3.0, 8.0] vs. 6.0 [IQR, 4.0, 9.0] days, p = 0.175) and postprocedural mean transvalvular gradient (10.00 [IQR, 8.00, 13.00] vs. 10.00 [IQR, 8.00, 12.00] mmHg, p = 0.724). CONCLUSION: Despite a higher cardiovascular disease burden in TC patients, TC-TAVR and TF-TAVR yielded similar outcomes. TC-TAVR may be a safe alternative when TF-TAVR is contraindicated.
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Lu et al. (2020) conducted a cohort in Transcatheter aortic valve replacement (n=306). Transcervical approach for TAVR vs. Transfemoral approach for TAVR was evaluated on 30-day all-cause mortality (HR 0.87, 95% CI 0.77-9.77, p=0.909). Transcervical TAVR was associated with similar 30-day mortality compared to transfemoral TAVR (HR 0.87; 95% CI 0.77-9.77; p=0.909), despite a higher baseline cardiovascular disease burden.
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