Early clinical outcomes after transaxillary versus transfemoral TAVI. Data from the Spanish TAVI registry
Pilar Jiménez-Quevedo 1 , Luis Nombela-Franco 2 , Erika Muñoz-García 3 , Raquel Del Valle-Fernández 4 , Ramiro Trillo 5 , José M de la Torre Hernández 6 , Luisa Salido 7 , Jaime Elizaga 8 , Soledad Ojeda 9 , Joaquín Sánchez Gila 10 , Bruno García Del Blanco 11 , Alberto Berenguer 12 , Garikoit Lasa-Larraya 13 , Cristóbal Urbano Carrillo 14 , Agustín Albarrán 15 , Rafael Ruiz-Salmerón 16 , José Moreu 17 , Livia Gheorghe 18 , Dabit Arzamendi 19 , Geoffrey Yanes-Bowden 20 , José Díaz 21 , Ignacio Pérez-Moreiras 22 , Miguel Artaiz 23 , Beatriz Vaquerizo 24 , Ignacio Cruz-González 25 , Valeriano Ruiz-Quevedo 26 , Roberto Blanco-Mata 27 , José Antonio Baz 28 , Manuel Villa 29 , Álvaro Ortiz de Salazar 30 , Valentín Tascón-Quevedo 31 , Sandra Casellas 32 , Raúl Moreno 33
Introduction and objectives: Transaxillary access (TXA) has become the most widely used alternative to transfemoral access (TFA) in patients undergoing transcatheter aortic valve implantation (TAVI).
The aim of this study was to compare total in-hospital and 30-day mortality in patients included in the Spanish TAVI registry who were treated by TXA or TFA access.
Methods: We analyzed data from patients treated with TXA or TFA and who were included in the TAVI Spanish registry. In-hospital and 30-day events were defined according to the recommendations of the Valve Academic Research Consortium. The impact of the access route was evaluated by propensity score matching according to clinical and echocardiogram characteristics.
Results: A total of 6603 patients were included; 191 (2.9%) were treated via TXA and 6412 via TFA access. After adjustment (n=113 TXA group and n=3035 TFA group) device success was similar between the 2 groups (94%, TXA vs 95%, TFA; P=.95). However, compared with the TFA group, the TXA group showed a higher rate of acute myocardial infarction (OR, 5.3; 95%CI, 2.0-13.8); P=.001), renal complications (OR, 2.3; 95%CI, 1.3-4.1; P=.003), and pacemaker implantation (OR, 1.6; 95%CI, 1.01-2.6; P=.03). The TXA group also had higher in-hospital and 30-day mortality rates (OR, 2.2; 95%CI, 1.04-4.6; P=.039 and OR, 2.3; 95%CI, 1.2-4.5; P=.01, respectively).
Conclusions: Compared with ATF, TXA is associated with higher total mortality, both in-hospital and at 30 days. Given these results, we believe that TXA should be considered only in those patients who are not suitable candidates for TFA.
CITATION Rev Esp Cardiol (Engl Ed). 2022 Jun;75(6):479-487. doi: 10.1016/j.rec.2021.07.019. Epub 2021 Oct 26.