A few studies recently reported controversial results with transfemoral transcatheter
aortic valve replacement (TF-TAVR) versus transapical transcatheter aortic valve replacement
(TA-TAVR), often without adequate adjusted analysis for baseline differences. Data
on patients who underwent TF-TAVR and TA-TAVR from the Observational Study of Effectiveness
of avR–tavI procedures for severe Aortic stenosis Treatment study were analyzed with
propensity score 1-to-1 matching. From a cohort of 1,654 patients (1,419 patients
underwent TF-TAVR and 235 patients underwent TA-TAVR), propensity score matching resulted
in 199 pairs of patients with similar operative risk (EuroSCORE II: TF-TAVR 8.1 ±
7.1% vs TA-TAVR, 8.4 ± 7.3%, p = 0.713). Thirty-day mortality was 8.0% after TA-TAVR
and 4.0% after TF-TAVR (p = 0.102). Postoperative rates of stroke (TA-TAVR, 2.0% vs
TF-TAVR 1.0%, p = 0.414), cardiac tamponade (TA-TAVR, 4.1% vs TF-TAVR 1.5%, p = 0.131),
permanent pacemaker implantation (TA-TAVR, 8.7% vs TF-TAVR 13.3%, p = 0.414), and
infection (TA-TAVR, 6.7% vs TF-TAVR 3.6%, p = 0.180) were similar in the study groups
but with an overall trend in favor of TF-TAVR. Higher rates of major vascular damage
(7.2% vs 1.0%, p = 0.003) and moderate-to-severe paravalvular regurgitation (7.8%
vs 5.2%, p = 0.008) were observed after TF-TAVR. On the contrary, TA-TAVR was associated
with higher rates of red blood cell transfusion (50.0% vs 30.4%, p = 0.0002) and acute
kidney injury (stages 1 to 3: 44.4% vs 21.9%, p <0.0001) compared with TF-TAVR. Three-year
survival rate was 69.1% after TF-TAVR and 57.0% after TA-TAVR (p = 0.006), whereas
freedom from major adverse cardiovascular and cerebrovascular events was 61.9% after
TF-TAVR and 50.4% after TA-TAVR (p = 0.011). In conclusion, TF-TAVR seems to be associated
with significantly higher early and intermediate survival compared with TA-TAVR. The
transfemoral approach, whenever feasible, should be considered the route of choice
for TAVR.
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Article Info
Publication History
Published online: November 05, 2015
Accepted:
October 14,
2015
Received in revised form:
October 14,
2015
Received:
September 8,
2015
Footnotes
The OBSERVANT study was supported by a grant ( Fasc. 1M30 ) from Italian Ministry of Health, Rome, Italy and Istituto Superiore di Sanità, Rome, Italy .
See page 250 for disclosure information.
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
