Transcervical approach versus transfemoral approach for transcatheter aortic valve replacement. (15th March 2021)

• Record Type: Journal Article
• Authors: Lu, Henri; Monney, Pierre; Fournier, Stephane; Pavon, Anna Giulia; Roguelov, Christan; Eeckhout, Eric; Muller, Olivier; Kirsch, Matthias
• Is Part Of: International journal of cardiology. Volume 327(2021)
• Page Start: 58
• Page End: 62
• Publication Date: 2021-03-15
• Subjects: Aortic valve stenosis -- Transcatheter aortic valve replacement -- Transfemoral -- Transcervical; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.11.026
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Objectives: The transfemoral (TF) approach is the gold-standard access route for transcatheter aortic valve replacement (TAVR). Alternative approaches, among which the transcervical (TC) approach, are needed in some patients. We aimed to compare TC-TAVR with TF-TAVR. Methods: All patients who underwent TAVR in our institution between 2016 and 2020, using Edwards SAPIEN family balloon-expandable transcatheter heart valves, were retrospectively included. Endpoints included 30-day all-cause mortality, procedural complications (according to the VARC-2 criteria), procedure duration, hospital length of stay (LOS) and echocardiographic outcomes. For 30-day all-cause mortality, we furthermore used a Cox proportional-hazards model to adjust for significant between-group differences in baseline characteristics as well as anesthesia modality. Results: TAVR was performed in 306 patients, using a TF approach ( n = 255) or a TC approach ( n = 51). TC-TAVR was associated with significantly higher STS scores (4.06 [IQR (interquartile range), 2.05, 5.56] vs. 2.97 [IQR, 2.08, 4.88], p < 0.001) and higher prevalence of peripheral artery disease, history of stroke, previous cardiovascular surgery. 30-day mortality (hazard ratio, 0.87 [0.77, 9.77], p = 0.909) and stroke rates (2.0% vs. 1.6%, p = 0.840) were similar, as well as procedural duration (74.0 [53.0, 99.5] vs. 77.0 [58.0, 98.0] minutes, p = 0.370), LOS (6.0 [IQR, 3.0, 8.0] vs. 6.0 [IQR, 4.0, 9.0] days, p = 0.175) and postprocedural mean transvalvular gradient (10.00 [IQR, 8.00, 13.00] vs. 10.00 [IQR, 8.00, 12.00] mmHg, p = 0.724). Conclusion: Despite a higher cardiovascular disease burden in TC patients, TC-TAVR and TF-TAVR yielded similar outcomes. TC-TAVR may be a safe alternative when TF-TAVR is contraindicated. Highlights: Transcatheter aortic valve replacement via a transfemoral access is not possible in 15% of cases. Transcervical and transfemoral accesses had similar results in terms of mortality, incidence of neurovascular complications, hospital length of stay, and improvement in aortic valve function. Transcervical access may be a good alternative when transfemoral access is unavailable.