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DECREASED PERIVALVULAR AORTIC INSUFFICIENCY IN SELF-EXPANDABLE DIRECT AORTIC TAVR COMPARED TO TRANSFEMORAL TAVR
Basel Ramlawi, MD, Odeaa Al Jabbari, MD, Walid K. Abu Saleh, MD, Colin Barker, MD, Chun Lin, MD, Manuel Reyes, MD, Neal Kleiman, MD, Michael J. Reardon, MD.
Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
OBJECTIVE: Direct aortic (DA) access is often required in cases where iliofemoral access for transcatherter aortic valve replacement (TAVR) is not adequate. Peripheral vascular diseases play a significant role in access planning. We reviewed our data comparing DA access vs. Transfemoral access for TAVR.
METHODS: The Methodist hospital database was reviewed from January 2011 till August 2014.This yielded 52 DA Access TAVR patient and 168 Transfemoral Access TAVR Patient. All clinical outcomes were analyzed retrospectively recorded from prospectively collected data. Decision for DA access or transfemoral access was by the TAVR team including the Surgeons and Cardiologist inputs prior to each procedure. All patients received the CoreValve self-expandable bioprosthesis. This was based on iliofemoral calcification, caliber, tortuosity and severity of peripheral vascular disease. Valve Academic Research Consortium 2 (VARC-2) definitions were used. Outcome was calculated from the day of the procedure to the date of death or discharge.
RESULTS: Off the two hundred and twenty patients we reviewed, fifty-two patients underwent DA access TAVR and one hundred and sixty eight patients underwent transfemoral access TAVR. Significantly less DA patients were male compared to transfemoral access patients (31% Vs. 58%). DA patients were found to have a significantly higher STS score, as well as higher percentage fitting into inoperable or extreme risk status. There was decrease in the perivalvular leak rate in DA Access compared to the transfemoral approach. 36.5% vs. 19.5% had no paravalvular leakage (PVL) and 63.5 % Vs 76% had Mild PVL. Refer to table for results.
CONCLUSIONS: Direct aortic access TAVR results in decreased PVL compared to ileofemoral access TAVR using self-expandable prosethsis; potentially due to improved positioning. Further study is warranted. 
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