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

BACKGROUND AND AIMS

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.

MATERIAL AND METHODS

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).

RESULTS

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).

CONCLUSION

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.