Differences in long-term outcome after femoral, subclavian andaortic approach to transcatheter aortic valve implantation(TAVI)

Introduction: Transcatheter aortic valve implantation (TAVI) represents an effective treatment of high-risk patients with severe aortic stenosis. There is no evidence of the long-term outcome of alternative approaches to TAVI. Aim: To asses the clinical outcome after subclavian and aortic TAVI compared to standard femoral approach. Methods: Prospective single-centre study comprise 228 consecutive TAVI patients (average age 79 years, logistic EuroSCORE 17.2, 53.5% females) divided in 1)Femoral, 2)Aortic and 3)Subclavian groups. More peripheral artery disease was found in both Aortic and Subclavian groups. The self-expandable CoreValve (Medtronic Inc., Minneapolis, MN USA) stented prosthesis was exclusively implanted. Results: In 99.6% the valve was successfully deployed. At 30 days the mortality and bleeding occurred in 2.6% and 3.5%, respectively, irrespective of the approach. The long-term major adverse cardiovascular events (MACE)and mortality rate were higher in patients after transaortic TAVI (mortality - 31.3% at 1 year; 65.6% at 2 years in aortic, 14,7%; 24.1% in femoral and 13.1%; 24.7% in subclavian groups, respectively; p=0.043, MACE; p=0.031). Conclusion: Compared to the femoral and subclavian approaches, patients after transaortic TAVI have significantly higher MACE and mortality rate up to 2 years.