Key result
Transaortic TAVR is linked to 4-fold higher 1-year mortality compared to subclavian access.
Why the study?
Limited data exist regarding safety and procedural feasibility of TAVR via transaortic and subclavian routes in patients unsuitable for transfemoral access.
Does the subclavian approach improve outcomes compared to the transaortic approach in patients undergoing TAVR without transfemoral access options?
Cohort (n=51)
No
Does the subclavian approach improve outcomes compared to the transaortic approach in patients undergoing TAVR without transfemoral access options?
Absolute Event Rate: 33.3% vs 8.3%
p-value: p=0.03
In patients ineligible for transfemoral TAVR, the subclavian approach with self-expanding valves was associated with significantly lower 12-month mortality compared to the transaortic approach.
SCL access was associated with lower 1-year mortality than TAo; small single-center data leave optimal nonfemoral access unresolved.
Background To compare outcomes among transcatheter aortic valve replacement (TAVR) performed via transaortic (TAo) and subclavian (SCL) approaches. Many patients are not amenable for TAVR via the transfemoral route due to peripheral vascular disease. Limited data exist regarding safety and procedural feasibility of TAVR via TAo and SCL routes. Methods Single-center study comparing patients treated with CoreValve® and Sapien XT® from May 2013 to August 2015 via subclavian (SCL) or transaortic (TAo) approach. All patients were deemed inappropriate for transfemoral access. Baseline characteristics, procedural feasibility, and outcomes were compared. Results A total of 27 (53%) patients underwent TAVR via the TAo approach and 24 (47%) via the SCL approach. Society of Thoracic Surgeons (STS) risk scores and patient age were similar: 11.33 versus 8.66; p = 0.13 and 84.7 years versus 82.6 years; p = 0.3, respectively. All patients in the SCL group received self-expandable valves. Overall vascular complications were low in both groups (SCL = 4.2% vs. TAo=3.7%). Length of hospital stay was marginally longer in the TAo group (mean 7.25 vs. 6.2 days, p = 0.119). There was a trend towards increased mortality associated with TA access (11.1% vs. 4%, p = 0.36) at 30 days that was significant after 12 months (33.3% vs. 8.3%, p = 0.03). Conclusion Our data shows a relatively low incidence of complications and comparable outcomes in these two groups. SCL or TAo access can be utilized as alternatives in patients with prohibitive ileofemoral anatomy, however, based on our limited data, subclavian access with self-expanding valves offers better outcomes.
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Khan et al. (2018) conducted a cohort in Patients requiring TAVR with no transfemoral access options (n=51). Transaortic (TAo) approach vs. Subclavian (SCL) approach was evaluated on Mortality at 12 months (p=0.03). Transaortic access for TAVR was associated with significantly higher mortality at 12 months compared to subclavian access (33.3% vs. 8.3%, p=0.03).
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