Thorac Cardiovasc Surg 2016; 64 - OP46
DOI: 10.1055/s-0036-1571505

Conventional vs. Transapical vs. Transfemoral Aortic Valve Replacement - Real World Comparison of 3,751 Patients

J. Börgermann 1, E. Emmel 1, S. Scholtz 2, S. Ensminger 1, N. Furukawa 1, B. Fujita 1, W. Scholtz 2, T. Becker 1, A. Zittermann 1, D. Horstkotte 2, O. Kuss 3, J. Gummert 1
  • 1Heart and Diabetes Center NRW Ruhr University of Bochum, Clinic for Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany
  • 2Heart and Diabetes Center NRW Ruhr University of Bochum, Clinic for Cardiology, Bad Oeynhausen, Germany
  • 3Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Inst. for Biometry and Epidemiology, Düsseldorf, Germany

Background and Hypothesis: Transcatheter aortic valve replacement (TAVR) is an established method in high-risk patients. Two aspects of this procedure are currently under discussion: 1.) Do the data acquired from randomized studies and registers justify expansion of the procedure to include younger and healthier patients? 2.) Is the transfemoral approach superior to the transapical approach with regard to mortality and periprocedural complications? Against this background we examined the mortality and morbidity of all patients who received an isolated conventional, transapical or transfemoral aortic valve replacement in accordance with the criteria of the Valve Academic Research Consortium (VARC)-2.

Methods: A prospective register was taken from a single center recording all conventional (CONV, n = 2,881), transapical (TAVR-TA, n = 363) and transfemoral (TAVR-TF, n = 570) aortic valve implantations during the period from July 2009 to October 2014. Using propensity score (PS) matching, first CONV and TAVRall (TA + TF) and then TAVR-TA and TAVR-TF were paired on the basis of 21 risk variables, creating comparable groups.

Results: 393 pairs CONV versus TAVRall within a moderate risk could be created (EuroSCORE 18.7 versus 18.5; STS 5.0 versus 5.4). Comparison revealed no difference for 30d mortality (4.6% CONV versus 5.1% TAVRall, p = 0.74), stroke (2.8% versus 2.0%, p = 0.48) or myocardial infarction (0.0 versus 0.3%, p = 0.50). Bleeding complications were significantly more frequent in the CONV, SM implantations and vascular complications in the TAVRall group. In the PS-adjusted comparison TAVR-TA versus TAVR-TF (289 pairs; EuroSCORE 25.1 versus 22.1; STS 6.8 versus 6.7) there was also no difference in the hard endpoints (30d mortality 4.9% TA versus 4.2% TF, p = 0.70; stroke 3.1% versus 2.8%, p = 0.81; myocardial infarction 0.4% versus 0.4%, p = 1.00). Here bleeding complications were significantly more frequent in the TA group, SM implantations and vascular complications in the TF group. Subgroup analysis showed an advantage of the TAVR procedure in octogenarians.

Conclusions: These data show that 1) conventional aortic valve replacement and TAVR are comparable in the moderate risk group, and 2) the two approaches, transapical and transfemoral, produce comparable results.