Abstract
Objectives: Subclavian (SC) and transapical (TA) approach are
the main alternatives to the default femoral delivery for transcatheter
aortic valve implantation (TAVI). Aim of this study was to compare,
complications and morbidity/mortality associated with SC and TA in a
long-term time frame.
Methods: From January 2007 to July 2015, 1,506 patients
underwent TAVI surgery in 36 United Kingdom TAVI centres. Primary
outcomes were complications according to VARC-2 criteria. The secondary
outcome was long-term survival.
Results: The enrolled patients were distributed as follows:
1,216 in the trans-apical (TA) group and 290 in the subclavian (SC)
group. There were no differences in the rates of acute myocardial
infarction, emergency valve-in-valve, paravalvular leak, balloon post
dilatation, cardiac tamponade, stroke, renal replacement therapy,
vascular injuries, and 30-days mortality among the groups. Conversely,
the rate of permanent pacemaker implantation (p = 0.02), the procedural
time duration (p = 0.04), and the 12-month mortality (p = 0.03) was
higher in SC than in TA, while in-hospital length of stay was reduced in
SC than in TA (p = 0.01). Up to 8-years, the long-term mortality was not
different among groups (p = 0.77), and no difference in long-term
survival between self vs balloon expandable device was found (p = 0.26).
Conclusions: According to our results, TA provided the best
12-months survival compared to SC, while the long-term survival up to 2,
900 days is not significantly different between groups, so SC and TA may
both represent a safe non-femoral access if femoral is precluded.
Key words : Aortic valve replacement; Transcatheter aortic valve
implantation; Minimally invasive surgery; Subclavian; Transapical.