gms | German Medical Science

Objectives: Treatment of valvular heart disease has experienced great changes since the introduction of TAVI. Most frequently used access routes are transfemoral (TF) and transapical (TA) approach. Although the transfemoral approach always was considered to be the less invasive one, no stressable data exist supporting this thesis. The present study reports intensive care data of both approaches.

Patients and methods: 615 patients were treated with TAVI, hereby 386 using the TA and 229 the TF approach. Clinical data were collected from prospective hospital’s database recordings.

Results: Mean patients age was 80.7+/-4.5 in TA- and 81.3+/-4.7 years in TF-group (p=n.s.). Logistic EuroSCORE was 18.2+/-12.7% in TA- and 17.8+/-12.2% in TF-group (p=n.s.). Hospital mortality was comparable for TA-TAVI (5.5%) and TF-TAVI (5.5%). The percentage of patients being discharged from ICU within the first 24 postoperative hours was higher in TA-TAVI-group (48.5% vs. 16.2%; p<0.01).. More TA-TAVI patients suffered from renal failure needing hemofiltration (9.5% vs. 2.0%; p<0.01). TF-TAVI, was associated with higher incidence of combined morbidity including major access complications, renal failure major bleeding, myocardial infarction, permanent pacemaker implant or stroke (49.5% vs. 24.0% in TA-TAVI; p<0.01).

Conclusions: TA and TF-TAVI provided comparable outcome, but TF-TAVI was associated with higher incidence of combined postoperative morbidity and prolonged ICU-stay