AUTHOR=Maier Julian , Lambert Thomas , Senoner Thomas , Dobner Stephan , Hoppe Uta Caroline , Fellner Alexander , Pfeifer Bernhard Erich , Feuchtner Gudrun Maria , Friedrich Guy , Semsroth Severin , Bonaros Nikolaos , Holfeld Johannes , Müller Silvana , Reinthaler Markus , Steinwender Clemens , Barbieri Fabian 

TITLE=Impact of route of access and stenosis subtype on outcome after transcatheter aortic valve replacement

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1256112

DOI=10.3389/fcvm.2023.1256112

ISSN=2297-055X

ABSTRACT=Previous analyses have reported outcomes of low-flow, low-gradient (LFLG) aortic stenosis (AS) patients undergoing transcatheter aortic valve replacement (TAVR) without stratifying by route of access. Differences in mortality between access routes have been established for high gradient (HG) patients and hypothesized to be even more pronounced in LFLG AS patients. This study aimed to compare outcomes of patients with LFLG or HG AS after transfemoral (TF) or transapical (TA) TAVR. Methods 910 patients, who underwent either TF or TA TAVR with median follow-up of 2.22 (IQR:1.22-4.03) years were included in this multicentre cohort study. 146 patients (16.04%) suffered from LFLG AS. Patients with HG and LFLG AS were stratified according to route of access and compared statistically.Operative mortality of HG and LFLG patients was comparable after TF access. Operative mortality was significantly increased for patients who underwent TA access (OR: 2.91 [1.54-5.48], p=0.001) and patients with LFLG AS (OR: 2.27 [1.13-4.56], p=0.02), which could be corroborated in a propensityscore matched subanalysis. The increase in risk of operative mortality was additive (OR for TA LFLG: 5.45 [2.35-12.62], p<0.001). LFLG patients who underwent TA access had significantly higher operative mortality rates (17.78%) than TF LFLG (3.96%, p=0.016) and TA HG patients (6.36%, p=0.024).HG patients had two-fold higher operative mortality after TA, compared to TF, access while LFLG patients had five-fold increased operative mortality rates. TA TAVR appears suboptimal for patients with LFLG AS. Alternatives, if TF is not possible, need to be assessed in prospective studies.