Clinical Outcomes after Transapical and Transfemoral Transcatheter Aortic Valve Insertion: An Evolving Experience

Background. Prior publications note increased adverse events after transapical compared with transfemoral access transcatheter aortic valve insertion (TAVI). We reviewed our TAVI experience to understand the differences in baseline patient characteristics and outcomes associated with the two access methods. Methods. The records were reviewed of 567 patients who underwent transfemoral (n = 351, 61.9%) and transapical (n = 216, 38.1%) TAVI from November 2008 through July 2015. Results. Compared with patients who underwent transfemoral access, the patients who underwent transapical access were older (82.0 ± 7.5 versus 79.6 ± 9.7 years; p = 0.006), had more peripheral vascular disease (78.2% versus 54.7%; p < 0.001), more previous coronary artery bypass graft operations (50.9% versus 32.5%; p < 0.001), and higher Society of Thoracic Surgeons predicted risk of mortality (9.4% ± 5.4% versus 8.8% ± 6.5%; p = 0.032). In-hospital and 30-day mortality rates, however, were similar between the two groups (transapical, n = 7, 3.2%; transfemoral, n = 13, 3.7%; p = 0.772). Follow-up echocardiography in 547 (100.0%) surviving patients at a median of 182 days (interquartile range, 35 to 420) demonstrated less paravalvular regurgitation grade of moderate or greater in patients who underwent transapical access (transapical, n = 6, 2.9%; transfemoral, n = 35, 10.4%; p = 0.001) but similar ejection fraction in the two groups (transapical, 55.4% ± 12.2%; transfemoral, 55.9% ± 13.0%; p = 0.419). Mortality rates at 1 year (transapical, 19.2% ± 3.0%; transfemoral, 14.7% ± 3.2%) and 4 years (transapical, 47.4% ± 6.4%; transfemoral, 42.7% ± 4.9%) were also similar between the two groups (p = 0.342). Conclusions. Transapical and transfemoral transcatheter aortic valve insertions result in similar operative and longer term mortality rates, despite differences in baseline patient risk. The findings support the concept that access does not influence treatment-related mortality rates.