G. Savulionyte1, D. M. Strauss1, A. Das1, K. J. Oh1, N. L. Owen-Simon1, H. A. Cohen1, B. O’Murchu1, B. P. O’Neill1, G. Wheatley1 1Temple University,Cardiovascular Surgery,Philadelpha, PA, USA
Introduction: Transcatheter aortic valve replacement (TAVR) has become standard of care for high surgical-risk patients with severe, symptomatic aortic valve stenosis. However, these patients have a high associated incidence of peripheral vascular disease which can preclude delivery from a transfemoral (TF) approach. Alternative delivery options include transapical (TA) and trans-aortic (TAo). The purpose of this study was to compare the outcomes of TAVR procedures performed via a TAo approach versus a non-TAo approach.
Methods: A retrospective review of patients undergoing TAVR from December 2013 to June 2015 was performed. Institutional Review Board approval was obtained. Demographic information and outcome data were collected regarding type of vascular access, procedural success, and lengths of stay in the intensive care unit and hospital. Statistical analysis was performed using SPSS Statistics.
Results: Forty-two patients (10 TAo, 30 TF, 2 TA) underwent TAVR. Average age for TAo patients was 73.6 years and 80.3 years for non-TAo patients (p=0.11). M:F ratio was 1:9 for TAo patients, and 3:5 for non-TAo patients (p=0.10). Average Society of Thoracic Surgeons (STS) score for TAo patients was 11.8, and 8.5 for non-TAo patients (p=0.18). [Figure 1] Seven (70%) patients in the TAo group had a diagnosis of chronic obstructive pulmonary disease (COPD), and 16 (50%) patients in the non-TAo group had COPD (p=0.27). The Medtronic CoreValve was used in 4 patients undergoing TAo and 11 patients with non-TAo (p=0.75), while the Edward SAPIEN prosthesis was implanted in 6 patients receiving TAo and 21 patients in the non-TAo group. Procedural success was 100% in both groups. Operative times averaged 144.2 (99-203) minutes in the TAo group and 117.9 (60-207) minutes in the TF/TA group (p=0.048). Four TAo patients (40%) were extubated in the operating room, while 29 (90.6%) non-TAo patients were extubated in the operating room (p=0.00066). Average intensive care unit stay (ICU) was 4 (2-12) days for TAo patients and 2.35 (0-11) days for non-TAo patients (p=0.14). Average hospital stay for TAo patients was 10.2 (4-28) days and 4.9 (2-14) days for non-TAo patients (p=0.035). 30-day mortality was 10% (n=1) in TAo group and 3.1% (n=1) in the non-TAo group (p=0.37). 1-year mortality was 10% (n=1) in TAo group and 9.3% (n=3) in the TF/TA group (p=0.95).
Conclusion: TAo is a suitable alternative access point for TAVR patients unable to undergo a TF approach due to severe peripheral vascular disease. Although TAo patients have a longer length of hospital stay, the outcomes are comparable to non-TAo patients. Future studies are needed to assess the financial impact of this approach.
