Transcervical approach versus transfemoral approach for transcatheter aortic valve replacement

Abstract Objectives The transfemoral (TF) approach is the gold-standard access route for transcatheter aortic valve replacement (TAVR). Alternative approaches, among which the transcervical (TC) approach, are needed in some patients. We aimed to compare TC-TAVR with TF-TAVR. Methods All patients who underwent TAVR in our institution between 2016 and 2020, using Edwards SAPIEN family balloon-expandable transcatheter heart valves, were retrospectively included. Endpoints included 30-day all-cause mortality, procedural complications (according to the VARC-2 criteria), procedure duration, hospital length of stay (LOS) and echocardiographic outcomes. For 30-day all-cause mortality, we furthermore used a Cox proportional-hazards model to adjust for significant between-group differences in baseline characteristics as well as anesthesia modality. Results TAVR was performed in 306 patients, using a TF approach (n = 255) or a TC approach (n = 51). TC-TAVR was associated with significantly higher STS scores (4.06 [IQR (interquartile range), 2.05, 5.56] vs. 2.97 [IQR, 2.08, 4.88], p  Conclusion Despite a higher cardiovascular disease burden in TC patients, TC-TAVR and TF-TAVR yielded similar outcomes. TC-TAVR may be a safe alternative when TF-TAVR is contraindicated.