Study Finds Comparable TAVR Outcomes With Transfemoral and Transapical Access

January 13, 2015—In Circulation: Cardiovascular Interventions, Gerhard Schymik, MD, et al published the long-term results of a study comparing access approaches for transcatheter aortic valve replacement (TAVR) in a real-world population with severe symptomatic aortic stenosis. The data demonstrate that in an experienced multidisciplinary heart team, either a transfemoral (TF) or a transapical (TA) access route can be used for TAVR with comparable results, concluded the investigators.

The background of the study is that TA access is generally perceived to be associated with increased morbidity compared with TF access for TAVR. In this study, the investigators aimed to compare access-related complications and survival using propensity score matching.

As summarized in Circulation: Cardiovascular Interventions, this prospective, single-center registry was composed of 1,000 consecutive patients undergoing TA and TF TAVR between May 2008 and April 2012. TA was performed in 413 patients, and TF was performed in 587 patients. 

In the study, patients who were treated via TA access were less often women and less had pulmonary hypertension. Further, they had more peripheral arterial disease, coronary artery disease, carotid stenosis, recurrent surgery, and a higher logistic EuroSCORE (24.3% ± 16.2% for TA vs 22.2% ± 16.2% for TF; P < .01). After building two propensity score–matched groups of 354 patients each with either access route (total of 708 patients), the baseline characteristics were comparable. 

The investigators found in this analysis that there was no significant difference in 30-day mortality (5.9% for TA vs 8.5% for TF; P = .19), rate of myocardial infarction (2.5% vs 2%; P = .61), stroke (2% vs 2.3%; P = .79), bleeding complications, pacemaker implantation rates, or moderate aortic insufficiency. Stage 1 renal complications were more common in TA patients (odds ratio, 2.81; 95% confidence interval [CI], 1.93–4.09), whereas major vascular complications were less common (odds ratio, 0.14; 95% CI, 0.06–0.29). Survival probability over the long-term was not statistically different (hazard ratio, 0.89; 95% CI, 0.72–1.10; log-rank Test, P = .27), reported the investigators in Circulation: Cardiovascular Interventions.