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Alternative TAVR access routes produced similar outcomes
Using transaortic, transapical and transcarotid access routes produced similar outcomes to the transfemoral route in an analysis of transcatheter aortic valve replacement procedures.
TAVR is the preferred alternative for patients with severe aortic stenosis who require aortic valve replacement but are too high risk for surgery, but many patients who are suited for TAVR are not candidates for transfemoral TAVR, the most common method, according to study background information.
Vinod H. Thourani, MD, and colleagues analyzed all TAVR procedures performed at Emory University from November 2011 to April 2012 (n=44; mean age, 78 years; 34.1% women; mean ejection fraction, 46.3%), comparing results between transfemoral access and nontransfemoral access procedures.
Transfemoral approaches were used in 40.9% of patients, and alternative approaches were used in 59.1% of patients. Among the patients requiring alternative approaches, 42.3% had a transapical approach, 46.2% had a transaortic approach and 11.5% had a transcarotid approach. The latter approach was used only in patients who were contraindicated for all other approaches.
Vinod H. Thourani
Researchers observed that the transfemoral group had a shorter median postoperative length of stay compared with the nontransfemoral group (3 days vs. 5.5 days; P=.022), which was the only difference in outcome between groups.
There were no differences in 30-day mortality or MACE (transfemoral, 11.1% vs. nontransfemoral, 3.9%; P=.38), vascular complications (transfemoral, 16.7% vs. nontransfemoral, 7.7%; P=.36) or heart blocks requiring a pacemaker (transfemoral, 11.1% vs. nontransfemoral, 0%; P=.08).
There were no reports in either group of MI, stroke, new dialysis, sepsis, multisystem organ failure, reoperation for hemorrhage or intra-aortic balloon counterpulsation.
The overall 30-day mortality rate was 6.8%, which outperformed the mean Society of Thoracic Surgeons predicted risk of mortality score of 12.6.
“Not only are these rates excellent, especially when compared with the expected mortality of patients treated medically, but they also indicate that alternative access routes can have results similar to those seen in the [transfemoral] route,” Thourani and colleagues wrote. “Overall, our experience demonstrates that minimal morbidity and mortality can be achieved using a multi-access approach to TAVR in patients considered nonoperative.”
Responding to similar data previously reported, the FDA recently decided to expand access to TAVR with the Sapien transcatheter valve to include inoperable patients with aortic stenosis in the United States who are in need of an alternate access route. For more on this news, read the full article here.
Disclosure: Several researchers report financial ties to Apica Cardiovascular, DirectFlow, Edwards Lifesciences, Medtronic, Sorin Medical and St. Jude Medical.