Abordajes intratorácicos versus extratorácicos en la implantación de válvula aórtica transcatéter no transfemoral: un análisis de puntuación de propensidad

Objectives

This study aimed to compare the outcomes of extrathoracic (ET) transcatheter aortic valve implantation (TAVI) to intrathoracic (IT) TAVI, specifically focusing on in-hospital or 30-day all-cause mortality (ACM), postoperative and 30-day complications, and 1-year ACM.

Methods

Between January 2009 and December 2023, 447 non-TF TAVI procedures were performed at our institution. Patients were categorized into IT (transapical) and ET (transcarotid and transaxillary) accesses. Propensity score matching was employed to compare outcomes between the two groups.

Results

Patients undergoing ET TAVI were older (mean age: 81.9 vs. 79.5 years) and had a higher prevalence of peripheral vascular and coronary artery diseases. ET TAVI was associated with a lower 30-day mortality rate (1.6% vs. 10.2%, P = .006) and fewer respiratory complications (0.8% vs. 19.9%, P < .001) compared to IT TAVI. The 1-year ACM was significantly lower in the ET group compared to the IT group. No significant differences were observed in procedural success rates, device success rates, or hemodynamic outcomes between the two groups. The ET group demonstrated consistently higher survival probabilities throughout the study period (P < .001).

Conclusions

ET TAVI appears to offer advantages in terms of lower short-term and 1-year mortality, as well as reduced postoperative complications compared to IT TAVI. Both approaches are comparable in terms of procedural and hemodynamic outcomes. These findings can assist clinicians in selecting the most appropriate TAVI approach tailored to individual patient profiles.