SPC365

TAVI via alternative access routes: patient selection and 10-year center experience

Session: Posters - F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Speaker: Bruno M. Rocha

Congress: CPC 2021
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.4 Valvular Heart Disease – Treatment
Session Type: Posters
FP Number: ---
Authors: Bruno M. Rocha; Tiago Nolasco; Rui Campante Teles; Gonçalo Cunha; Pedro Lopes; Catarina Brízido; Gustavo Mendes; Francisco Gama; Mariana Gonçalves; Afonso Félix De Oliveira; Daniel Matos; Christopher Strong; Sérgio Madeira; Nelson Vale; Márcio Madeira; João Brito; Luís Raposo; Pedro Gonçalves; Henrique Mesquita Gabriel; Carlos Aguiar; Miguel Sousa-Uva; Miguel Abecasis; Manuel Ameida; José p Neves; Miguel Mendes

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Background</span></span></u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: Femoral access is considered the gold standard for transcatheter aortic valve implantation (TAVI). However, this route might be precluded due to the presence of tortuosity, small vessel diameter and/or peripheral artery disease. We aimed to investigate TAVI through an alternative access (AA), focusing on the selection criteria and clinical outcomes compared to the femoral route (TF).</span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods</span></span></u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: We conducted an all-comers longitudinal single-centre prospective registry in whom a TAVI was performed. The feasibility, safety and efficacy of TAVI by means of an access route other than standard TF&nbsp;was assessed, according to the VARC-2 criteria. The prospective surgical criteria used at our institution to accept an AA route were: a) TF deemed inappropriate; b) acceptable haemorrhagic risk; c) acceptable general anaesthesia risk; and d) adequate anatomy and diameter within acceptable range (subclavian, axillar, transaortic) or e) age &lt; 85 years and non-frail patient (transapical). The primary endpoint was all-cause death at 1-year.</span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results</span></span></u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: From 2008 to 2018, there were 548 patients submitted to TAVI [median age 84 (79-87) years, males 45.4%]. An AA route was used in 100 patients (79 trans-apical, 9 trans-aortic, and 12 trans-subclavian), with a decreasing rate over follow-up (-11% per year). Compared to TF, these patients were younger [80 (77-84) vs. 85 (80-87) years; p&lt;0.001) with a similar baseline surgical risk as per EuroSCORE II [5.1 (3.3-9.0) vs. 4.7 (3.3-7.0); p=0.410). AA patients presented a higher burden of atherosclerotic disease,&nbsp;namely coronary (54.0 vs. 41.3%; p&lt;0.001) and peripheral artery disease (35.0 vs. 16.5%, p&lt;0.001) despite a lower number of other comorbidities (e.g. glomerular filtration rate &lt;50mL/min: 53.1 vs. 64.8%; p=0.030). Left ventricular ejection fraction (56 &plusmn; 13 vs 55 &plusmn; 12%; p=0.203) and aortic stenosis severity (e.g. valve area: 0.70 &plusmn; 0.19 vs. 0.67 &plusmn; 0.18cm<sup>2</sup>; p=0.302) were similar between groups. Haemorrhagic events (minor or major) following TAVI were less often documented in the AA group (11.0 vs 21.7%; p=0.015), contrasting with <em>de novo</em> atrial fibrillation (18.5 vs 7.6%; p=0.048). Overall, 67 patients met the primary endpoint (18.8 vs 16.2%; p=0.584). After adjusted </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">multivariate analysis, t</span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">he independent predictors of one-year mortality did not include the TAVI access route.</span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion</span></span></u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: In the first 10 years of experience, 1 in every 6 patients was treated with a TAVI by means of an AA, most often trans-apically initially and, nowadays, via a trans-subclavian approach. The use of meticulous prospective selection criteria seems to explain the one-year similar results, regardless of the access route.</span></span></span></span></p>