Abstract:
Objective: The aim of this study was to determine long-term mortality in patients that underwent transfemoral or transapical TAVI, and to identify factors that correlate with long-term deaths.

Method:

From a single institution's TAVI database, all patients that underwent TAVI with a minimum follow-up duration of 6 years were analysed. The population was analysed based on the access route (transfemoral TAVI or transapical TAVI). Cox regression and Kaplan-Meier survival analysis were conducted.

Results:

A total of 682 patients that underwent TAVI were included in the analysis (transfemoral TAVI n = 408; transapical TAVI n = 271). The mean Society of Thoracic Surgeons (STS) score was 4.2 ± 2.5 Mortality at 30 days (11.0 vs 11.4%; p=0.84) was similar in both groups. Several procedural outcomes were less favourable in the transfemoral group. The percentage of new pacemaker implantations (15.7% vs 4.1%; p<0.000), occurrence of all stroke (4.9% vs 0.7%; p=0.003) and major vascular complications (12.8 vs 16.1; p=0.005), was higher in the transfemoral group than in the transapical group. However, in the long-term data the transfemoral access was associated with a better survival outcome (hazard ratio [HR] 0.78, 95% CI 0.63 to 0.97, p = 0.028). Patients with diabetes mellitus (HR 1.31, 95% CI 1.05-1.63; p=0.017), a high STS score (HR 1.06, 95% CI 1.03-1.10, p=0.001), major or minor vascular complications (HR 1.19, 95% CI 1.17-1.63, p=0.028), and major bleeding (HR 1.29, 95% CI 1.07-1.46, p=0.013) were correlated with a worse long-term outcome.

Conclusion:

In conclusion, the overall long-term survival of patients with severe aortic stenosis that were approved to undergo TAVI were <50% irrespective of the access method. Our long-term results show that the transfemoral approach should be preferred over the transapical approach whenever possible. In addition, strategies geared toward reducing vascular complications and major bleeding are still needed, as these variables negatively influence long-term mortality.