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Transcatheter Aortic Valve Replacement Using Transaortic Access

Wednesday, September 7, 2016

Submitted by

Ruben Osnabrugge

Source

Source Name: JACC Interventions

Source URL: http://interventions.onlinejacc.org/article.aspx?articleid=2547581

Author(s)

Bapat V, Frank D, Cocchieri R, Jagielak D, Bonaros N, Aiello M, Lapeze J, Laine M, Chocron S, Muir D, Eichinger W, Thielmann M, Labrousse L, Arne Rein K, Verhoye J, Gerosa G, Baumbach H, Bramlage P, Deutsch C, Thoenes M, Romano M

This multistudy registry, entitled ROUTE, studied the effectiveness and safety of transaortic access for TAVI in 301 patients. Mean age was 82 years and mean STS Score 9.0. Valve success was 97%. Total 30-day mortality was 6.1%, and VARC-2 defined endpoints were reported : stroke (1.0%), MI (1.0%), major vascular complications (3.4%), life-threatening bleeding (3.4) and acute kidney injury (9.5%). Moderate or severe paravalvular leak was present in 3.3% of the cases and 8.8% required a pacemaker.

In the accompanying editorial by Thourani et al. it was highlighted non-transfemoral TAVI accounted for almost 50% of the TAVI cases, but with of the current SAPIEN 3 valves the transfemoral route was used in 90% of the cases. The authors stress that transfemoral TAVI will be the mainstay of TAVI treatment and only the minority of patients are likely to undergo non-transfemoral TAVI.