Meertens Max M, Adam Matti, Beckmann Andreas, Ensminger Stephan, Frerker Christian, Seiffert Moritz, Sinning Jan-Malte, Bekeredjian Raffi, Walther Thomas, Beyersdorf Friedhelm, Möllmann Helge, Balaban Ümniye, Eghbalzadeh Kaveh, Rudolph Tanja K, Bleiziffer Sabine
Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
Department of Cardiac and Pediatric Cardiac Surgery, Evanglish Clinical Center Niederrhein, Heart Center Duisburg, Duisburg, Germany.
Clin Res Cardiol. 2025 Mar;114(3):323-331. doi: 10.1007/s00392-024-02402-9. Epub 2024 Mar 4.
In patients not suitable for transfemoral transcatheter aortic valve implantation (TAVI), several access strategies can be chosen.
To evaluate the use and patient outcomes of transaxillary (TAx), transapical (TA), and transaortic (TAo) as alternative access for TAVI in Germany; to further evaluate surgical cutdown vs. percutaneous TAx access.
All patients entered the German Aortic Valve Registry (GARY) between 2011 and 2019 who underwent non-transfemoral TAVI were included in this analysis. Patients with TA, TAo, or TAx TAVI were compared using a weighted propensity score model. Furthermore, a subgroup analysis was performed for TAx regarding the percutaneous or surgical cutdown approach.
Overall, 9686 patients received a non-transfemoral access. A total of 8918 patients (92.1%) underwent TA, 398 (4.1%) TAo, and 370 (3.8%) TAx approaches. Within the TAx subgroup, 141 patients (38.1%) received subclavian cutdown, while 200 (54.1%) underwent a percutaneous approach. The TA patients had a significantly lower 30-day survival than TAx patients (TA 90.92% vs. TAx 95.59%, p = 0.006; TAo 92.22% vs. TAx 95.59%, p = 0.102). Comparing percutaneous and cutdown TAx approaches, no significant differences were seen. However, more vascular complications occurred (TA 1.8%, TAo 2.4%, TAx 12.2%; p < .001), and the hospital length of stay was shorter (TA 12.9 days, TAo 14.1 days, TAx 12 days; p < .001) after TAx access.
It may be reasonable to consider TAx access first in patients not suitable for TF-TAVI, because the 30-day survival was higher compared with TA access and the 1-year survival was higher compared with TAo access. It remains important for the heart teams to offer alternative access modalities for patients not amenable to the standard TF-TAVI approaches.
对于不适合经股动脉经导管主动脉瓣植入术（TAVI）的患者，可以选择多种入路策略。
评估经腋动脉（TAx）、经心尖（TA）和经主动脉（TAo）作为德国TAVI替代入路的使用情况和患者预后；进一步评估手术切开与经皮TAx入路。
纳入2011年至2019年期间进入德国主动脉瓣注册研究（GARY）并接受非经股动脉TAVI的所有患者进行分析。使用加权倾向评分模型对接受TA、TAo或TAx TAVI的患者进行比较。此外，对TAx入路的经皮或手术切开方法进行亚组分析。
总体而言，9686例患者接受了非经股动脉入路。共有8918例患者（92.1%）接受TA入路，398例（4.1%）接受TAo入路，370例（3.8%）接受TAx入路。在TAx亚组中，141例患者（38.1%）接受锁骨下动脉切开，200例（54.1%）接受经皮入路。TA入路患者的30天生存率显著低于TAx入路患者（TA为90.92%，TAx为95.59%，p = 0.006；TAo为92.22%，TAx为95.59%，p = 0.102）。比较经皮和切开TAx入路，未见显著差异。然而，TAx入路后血管并发症更多（TA为1.8%，TAo为2.4%，TAx为12.2%；p < 0.001），住院时间更短（TA为12.9天，TAo为14.1天，TAx为12天；p < 0.001）。
对于不适合经股动脉TAVI的患者，首先考虑TAx入路可能是合理的，因为与TA入路相比30天生存率更高，与TAo入路相比1年生存率更高。对于不适合标准经股动脉TAVI方法的患者，心脏团队提供替代入路方式仍然很重要。
