Resultados comparativos de las vías transvasculares no femorales en un mismo centro, 11 años de nuestro programa TAVI

Introduction and objectives

Alternative “non-femoral” access routes are presented as an alternative option in current clinical guidelines for transcatheter valve implantation when the femoral route is not possible. Our main objective is describing the activity carried out in our center and to show the results of a series of transcatheter aortic prostheses implanted exclusively by a team of cardiovascular surgeons.

Methods

Descriptive study of a series of TAVIs implanted by cardiovascular surgeons with non-transfemoral approach. Data collection on preoperative variables and postoperative variables.

Results

304 non-transfemoral TAVI: 21 implants with transaortic access (6.91%), 62 transapical access (20.40%), 168 transaxillary (55.26%) and 53 transcarotid (17.43%). A total of 69.73% (212) implantations were with self-expandable prostheses and 30.27% (92) with balloon expandable prostheses. A total of 65 leaks (21.38%) were registered. First year mortality was 5.38%. Three ischaemic strokes (0.98%).

Forty-five patients (14.80%) required implantation of a permanent pacemaker. There were 4 vascular complications in the case of the transaxillary approach (2.43%) and 1 in the case of the transapical approach (1.62%).

Conclusions

Balloon expandable prostheses have lower blockage rates and fewer periprosthetic leaks but slightly higher mortality (non-significant). The transaxillary and transcarotid access are not inferior to the transfemoral access in terms of morbidity and mortality. Vascular non-transfemoral access should be considered an option when they are of better quality. The transcarotid access is positioning itself as a possibly better alternative to the transaxillary access.