Transaortic Transcatheter Aortic Valve Implantation as a Second Choice over the Transapical Access

In this report, we present our experience with the transaortic transcatheter aortic valve implantation using the SAPIEN valve. The procedural success, 30-day outcome, and survival up to 2 years are compared with the transapical access performed in patients in our institution.

Of a total of 282 transcatheter aortic valve implantation patients, 100 consecutive patients had a non-transfemoral approach. The transaortic and transapical access routes were used in 36 and 64 patients, respectively. The transaortic group had a higher mean logistic EuroSCORE (32.6 vs 25.2, p = 0.021) and more patients with left ventricular ejection fraction less than 40% (33.3% vs 14.1%, p = 0.023).

The respective technical success rates for the transaortic and transapical groups were 100% and 95.2% (p = NS). There were significantly more perioperative hemodynamic problems necessitating cardiopulmonary resuscitation or mechanical circulatory support in the transapical group (18.8% vs 2.8%, p = 0.023). The transaortic group had a slightly shorter hospital stay (7 vs 8 days, p = 0.018). The 30-day mortality was 8.6% and 10.9% in the transaortic and transapical group, respectively (p = NS). Combined safety outcome was similar in both groups at 30 days. The respective 1-year survival rates for the transaortic and transapical groups were 71.5% and 68.3%, respectively (p = NS).

The trans transcatheter aortic valve implantation is a considerable choice to transapical approach. Despite a higher risk patient cohort, the clinical outcome is at least comparable to the transapical transcatheter aortic valve implantation, and it can be utilized as a second choice for patients with prohibitive iliac-femoral anatomy for transfemoral access.