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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Propensity-matched comparison of clinical outcomes after transaortic versus transfemoral aortic valve replacement

Thomas Chollet1, Bertrand Marcheix, Nicolas Boudou

  • 1Department of Cardiology, Rangueil University Hospital, Toulouse, France.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|July 4, 2018
PubMed

Insights

Transaortic (TAo-AVR) and transfemoral (TF-AVR) transcatheter aortic valve replacement show similar mortality rates. However, TAo-AVR is linked to increased risks of new atrial fibrillation, bleeding, and transfusions.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Transcatheter aortic valve replacement (TAVR) is a crucial treatment for severe aortic stenosis.
  • Transfemoral access (TF-AVR) is the predominant TAVR approach, but alternative access routes are being explored.
  • Transaortic access (TAo-AVR) offers a potential alternative, particularly when TF-AVR is challenging.

Purpose of the Study:

  • To compare the long-term clinical outcomes of transaortic (TAo-AVR) versus transfemoral (TF-AVR) transcatheter aortic valve replacement.
  • To evaluate mortality rates and procedural complications associated with each access route.

Main Methods:

  • A propensity score-matched analysis comparing consecutive TAo-AVR and TF-AVR cases from January 2012 to December 2015.
  • Primary endpoints included 30-day and one-year mortality.
  • Patient characteristics, procedural data, and complication rates were analyzed.

Main Results:

  • No significant differences in 30-day or one-year mortality were observed between TAo-AVR and TF-AVR groups in the overall or matched cohorts.
  • TAo-AVR patients had a higher incidence of peripheral artery disease and coronary artery disease.
  • Transaortic access was associated with significantly higher rates of new-onset atrial fibrillation, life-threatening bleeding, and transfusion requirements.

Conclusions:

  • Transaortic access is a viable alternative to transfemoral access for TAVR, demonstrating comparable long-term mortality.
  • The choice of access route should consider the increased risk of specific complications with TAo-AVR, including arrhythmias and bleeding.
  • Further research may refine patient selection criteria for optimal outcomes with different TAVR access strategies.
Abstract

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