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

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Devices

Background:

• Transcatheter aortic valve implantation (TAVI) is a crucial procedure for aortic stenosis.
• Non-transfemoral TAVI approaches, including transaortic and transapical, are used for patients with unsuitable iliofemoral anatomy.
• Comparing these access routes is essential for optimizing patient outcomes.

Purpose of the Study:

• To compare the procedural success, 30-day outcomes, and up to 2-year survival of transaortic TAVI versus transapical TAVI.
• To evaluate the safety and efficacy of the SAPIEN valve via transaortic access.

Main Methods:

• A retrospective analysis of 100 non-transfemoral TAVI patients.
• 36 patients underwent transaortic access, and 64 underwent transapical access.
• Comparison of baseline characteristics, procedural success, perioperative complications, and survival rates.

Main Results:

• Technical success rates were 100% for transaortic and 95.2% for transapical (p=NS).
• The transaortic group experienced fewer perioperative hemodynamic issues (2.8% vs 18.8%, p=0.023) and shorter hospital stays (7 vs 8 days, p=0.018).
• 30-day and 1-year survival rates were comparable between groups (p=NS).

Conclusions:

• Transaortic TAVI is a valuable alternative to the transapical approach, offering comparable clinical outcomes.
• This method is particularly useful for patients with prohibitive iliofemoral anatomy for transfemoral access.
• Transaortic TAVI demonstrates safety and efficacy, even in a higher-risk patient cohort.