Outcomes After Transcatheter Aortic Valve Implantation: Transfemoral Versus Transapical Approach

Background. Transcatheter aortic valve implantation is commonly implanted through a transfemoral (TFA) or transapical approach (TAA) for patients with severe aortic stenosis. This study aimed to describe the clinical and echocardiographic outcomes of TFA versus TAA. Methods. Clinical and echocardiographic evaluations were performed at baseline, post-TAVI (transcatheter aortic valve implantation), at 6 and 12 months follow-up in 107 consecutive patients who underwent TAVI with balloon-expandable valves. Results. The TFA was performed in 44% and the remaining patients underwent TAA. Although procedural complications were not significantly different in both approaches, more vascular complications were observed in the TFA group (18% vs 5%, p = 0.053). Patients with TAA required shorter fluoroscopy time (median 5 vs 12 min, p < 0.001), less contrast volume (median 80 vs 173 mL, p < 0.001), and similar length of hospitalization, as compared with TFA. Importantly, the early 30-day mortality (TFA: 11.1% vs TAA: 8.5%, p = 0.74) were not significantly different between the 2 approaches. Midterm survival at 6 months and 1 year was comparable between TFA and TAA (6 months: 88.9% vs 85.7% and 1 year: 80.2% vs 85.7%). All patients achieved immediate and sustained improvements in transvalvular hemodynamics, together with significant left ventricular mass regression (137 +/- 39 vs 113 +/- 30 g/m(2), p < 001) and left atrial volume reduction (48 +/- 17 vs 34 +/- 14 mL/m(2), p < 0.001) at 6 months or less. Conclusions. Early, midterm, clinical, and echocardiographic outcomes were comparable in both approaches. However, TAA has the additional benefit of reducing radiation exposure and contrast use intraoperatively without prolonging the length of hospital stay. (Ann Thorac Surg 2011;92:1244-51) (C) 2011 by The Society of Thoracic Surgeons