Transapical‐transcatheter aortic valve implantation in patients without transvascular options: Modified transapical approach

Abstract

Objectives: Outcomes in patients with iliofemoral and concomitant iliofemoralremote arteriopathies who cannot undergo transfemoral or other alternative transvascular approaches have not been studied so far. This study aimed to evaluate the early and midterm outcomes after transapical (TA)-transcatheter aortic valve implantation (TAVI) in patients with femoral and femoral-remote arteriopathies who cannot undergo transvascular approaches.Methods: Multimorbid patients with severe aortic stenosis and distinct panarteriopathy underwent TA-TAVI treatment between January 2012 and January 2021 at the authors' institution. Second-and third-generation self-and balloon-expanding valves were used. For patients without arterial access, TA-TAVI was modified to the artery-no-touch technique.Results: Seventy-two consecutive elderly patients (78.2 ± 6.9 years; 73% male) were included in the study. The Society of Thoracic Surgery-Predicted Risk of Mortality score was 7 ± 5%. No procedural deaths or conversion to conventional surgery was registered. The 30-day and midterm mortality rates were 5% and 28%, respectively.The median time of freedom from a composite of death and cardiocerebral adverse events was 34.3 months (95% confidence interval: 17.6-51.1). The rate of moderate/severe paravalvular leakage was 0%. The pacemaker rate was 11%. Conclusions: TA-TAVI is a safe method with low-rate procedural complications and shows good early and midterm outcomes in patients with extensive panarteriopathy for whom transfemoral and other alternative transvascular approaches are contraindicated or at high interventional risk. The modified artery-no-touch TA-TAVI method is safe and feasible for selected patients with no other possible arterial approach.

Modified transapical transcatheter aortic valve replacement: A new tailored approach to the aortic valve

“…Some studies have suggested that TA-TAVR is associated with poor outcomes compared with SAVR. 4,5 In this context, this report by Useini et al 6 in this issue of the Journal is timely and relevant. The authors present data regarding 72 consecutive patients who underwent aortic valve replacement using a modified artery-no-touch TA transcatheter aortic valve implantation (TAVI).…”