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OBJECTIVES: Transcather aortic valve implant is nowadays considered the alternative therapy for patients inoperable or with an high surgical risk suffering for severe aortic stenosis. The aim of this study is to compare results of transfemoral (TF) and transaxillary (TAx) TAVI using CoreValve ReValving system.
METHODS: 123 patients underwent TAVI from November 2007 to May 2011 in our site with a CoreValve ReValving System using different routes: 95 with a transfemoral, 28 transaxillary approach. 44 (35.8%) patients received a 26 diameter valve and 79 (64.2%) patients a 29 diameter valve.
RESULTS: At screening patient clinical features were homogeneous with an higher rate of copathologies in transaxillary group, in particular rate of COPD was 57.14% in TAx and 38.94% in TF group and peripheral vascular disease rate was 60.7% in TAx and 25,2% in TF. Acute kidney injury rate was 36.8% in TF and 14.2% in TAx (p=0.0042). Paravalvular aortic regurgitation≥2+ rate was 0% in TAx and 26.3% in TF TAVI (p=0.0024). Major vascular complications rate was 13.7% in TF and 7.1% in TAx, minor vascular complications rate was 10.7% in TAx and 15.8% in TF group. Rate of post-procedural PM implant was 21.6% in TAx and 27.3% in TF. 30’ days mortality was 16.3% in TF and 3.5% in TAx, 30 days’ MACCEs incidence was 7.1% in TAx and 11.6% in TF. Actuarial survival was 90.5±3.7% at 18 months in TF and 87.5±11.7% at 12 months in TAx group.
CONCLUSIONS: In our experience survival at long term follow up in TAx and TF are similar, also considering the higher rate of comorbidities in TAx group. Lower incidence of post procedural complications and of paravalvular leakage, due to less contrast administred and to a more precise control of the valve in TAx approach, make this access more feasible for TAVI.