Key result
Alternative access TAVR is linked to ~4-fold higher 30-day CV mortality vs. transfemoral access.
Why the study?
Alternative access is still required for a significant proportion of patients undergoing TAVR, but comparative clinical outcomes versus transfemoral access are not well defined.
Does alternative access TAVR increase mortality and adverse events compared to transfemoral access in patients undergoing TAVR?
Cohort (n=600)
Does alternative access TAVR increase mortality and adverse events compared to transfemoral access in patients undergoing TAVR?
Absolute Event Rate: 5.1% vs 1.3%
p-value: p=0.04
Alternative access for TAVR is associated with higher rates of postoperative adverse events and mortality compared to transfemoral access, supporting the preference for the transfemoral route when feasible.
AA-TAVR linked to higher short-term mortality and complications than TF; leaves open whether access site independently drives outcomes in adjusted analyses.
BACKGROUND: Alternative access (AA) is still required for a significant proportion of patients undergoing transcatheter aortic valve replacement (TAVR). We sought to compare the clinical outcomes of patients undergoing AA vs transfemoral (TF) access. METHODS: We retrospectively evaluated the outcomes of patients undergoing AA-TAVR between April 2011 and November 2016, and compared them with those who had TF-TAVR. Chi-square and Mann-Whitney U-tests were used to compare the groups and Kaplan-Meier analysis was performed to estimate long-term survival. RESULTS: TAVR was performed in a total of 600 patients, of which 78 (13%) had AA and 522 (87%) had TF access. Patients undergoing AA were younger, and had higher prevalence of chronic obstructive pulmonary disease, peripheral vascular disease, prior myocardial infarction, and prior sternotomy. Greater than mild paravalvular regurgitation (4.2% vs 0.0%; P=.04) and unplanned vascular surgery (5.4% vs 1.3%; P=.09) were more frequent in the TF group. However, patients who underwent AA had longer hospital stay (median 4 days [interquartile range, 3-7 days] vs 3 days [interquartile range, 3-4 days]; P<.001) and an increased incidence of prolonged ventilation (5.1% vs 1.3%; P=.06), 30-day all-cause (5.1% vs 1.7%; P=.08), and cardiovascular mortality (5.1% vs 1.3%; P=.04). The 6-month (15.7% vs 5.7%; P<.01) and 12-month (16.7% vs 10.2%; P=.07) mortality rates were higher for patients undergoing AA. The usage of AA significantly decreased over time (P=.01), primarily driven by a decrease in transapical (P<.001) and direct aortic access (P=.02). CONCLUSIONS: AA-TAVR is associated with an increased incidence of postoperative adverse events, including mortality, when compared with those undergoing TF access.
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Pineda et al. (2019) conducted a cohort in Transcatheter aortic valve replacement (TAVR) (n=600). Alternative access (AA) TAVR vs. Transfemoral (TF) access TAVR was evaluated on 30-day cardiovascular mortality (p=0.04). Alternative access TAVR was associated with higher 30-day cardiovascular mortality compared to transfemoral access (5.1% vs 1.3%; P=0.04), alongside increased 6-month and 12-month mortality.
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