Short- and Mid-Term Outcomes in Patients Deemed Inoperable Undergoing Transapical and Transfemoral TAVR with an STS-PROM below Four Percent.

Verena Veulemans,Ralf Westenfeld,Christian Jung,Arash Mehdiani,Armin Borhan Azad,Shouheng Goh,Oliver Maier,Artur Lichtenberg,Christian Drake,Katharina Hellhammer,Kerstin Piayda,Amin Polzin,Malte Kelm,Tobias Zeus

doi:10.3390/jcm10132993

Verena Veulemans, Ralf Westenfeld + Show 12 more

Open Access

https://doi.org/10.3390/jcm10132993

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Abstract

Transapical (TA) TAVR is known to be associated with increased mortality and vascular complications compared with transfemoral (TF) TAVR in high-risk and inoperable patients. However, safe alternative access methods remain crucial. We aimed to (1) evaluate the 30-day and 1-year outcomes comparing TA and TF TAVR in patients with an STS-PROM of <4% deemed inoperable and (2) determine dependent and independent predictors for all-cause one-year mortality. Data were collected from a single-center registry consisting of 340 eligible patients. One-to-one propensity score matching was performed (n = 50 TA, n = 50 TF). Primary endpoints were all-cause mortality, stroke, and major bleeding. Predictors for all-cause one-year mortality were evaluated. Thirty-day mortality (TF vs. TA: 0.0% vs. 4.0%; p = 0.153) was comparable in both cohorts. One-year all-cause mortality was twice as high in TA patients (TF vs. TA: 10.0% vs. 20.0%, p logrank = 0.165, HR 2.10). Cerebrovascular events and major bleeding during one-year follow-up were similar. The multivariate analysis identified hemoglobin <12 g/dL at admission and dual antiplatelet therapy as strong predictors for one-year mortality. Although femoral access is the primary access with favorable 30-day and 1-year results, transapical access was successful for patients unsuitable for TF TAVR, showing acceptable short- and mid-term results in inoperable patients with low-risk profiles.

Highlights

Baseline characteristics did differ according to the particular risk profile in the different access routes
Studies have frequently reported worse outcomes comparing transapical to transfemoral transcatheter aortic valve replacement (TAVR) in patients at high surgical risk
This is the first real-world study comparing short- and mid-term outcomes in transapical and transfemoral TAVR concerning patients that were deemed inoperable by the heart team but had an STS-PROM below four percent

Summary

Introduction

Most patients can be treated with TF TAVR today using smaller delivery sheaths and newer-generation valves, up to one-third of eligible patients may not be suitable for this approach [3]. With the expansion of TAVR in low-risk patients [4], safe alternative access methods remain crucial for patients without adequate transfemoral access. There are no research data regarding the outcomes of formally low-risk patients undergoing transapical compared with transfemoral TAVR who were deemed inoperable due to specific individual reasons. We aimed to (1) evaluate the 30-day and 1-year outcomes comparing TA and TF TAVR in inoperable patients with an STS-PROM of

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