Transapical versus transfemoral aortic valve implantation: a multicenter collaborative study

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Device Technology

Background:

• Transcatheter aortic valve implantation (TAVI) is a crucial treatment for aortic stenosis.
• Direct comparisons between transapical aortic valve implantation (TA-AVI) and transfemoral aortic valve implantation (TF-AVI) are lacking.
• Understanding the comparative outcomes of different TAVI approaches is essential for clinical decision-making.

Purpose of the Study:

• To compare the short-term and midterm outcomes of TA-AVI versus TF-AVI.
• To evaluate differences in mortality, complications, and hospital stay between the two TAVI techniques.
• To identify factors influencing outcomes in TA-AVI and TF-AVI procedures.

Main Methods:

• Pooled analysis of data from four European centers.
• Multivariable analysis to minimize differences between TA-AVI and TF-AVI groups.
• Endpoints defined by Valve Academic Research Consortium-I criteria at 30 days and 1 year.
• Primary endpoints included 30-day and follow-up all-cause mortality.

Main Results:

• TA-AVI patients had higher predicted mortality risk (logistic European System for Cardiac Operative Risk Evaluation and Society of Thoracic Surgeons scores) and more comorbidities.
• TA-AVI was associated with increased 30-day all-cause mortality (OR 3.12) and 1-year mortality (HR 1.88).
• TF-AVI had higher rates of major and minor vascular complications, and TA-AVI was linked to longer in-hospital stays.

Conclusions:

• In low-volume centers, TA-AVI is associated with increased all-cause mortality and longer hospital stays compared to TF-AVI.
• TA-AVI demonstrated fewer vascular complications than TF-AVI.
• Further investigation into the interaction between procedural experience and treatment type is needed to guide the choice between TA-AVI and TF-AVI.