The following is a summary of “Non-femoral focused transaxillary access in TAVI: GARY data analysis and future trends,” published in the March 2024 issue of Cardiology by Meertens et al.

CardiologyFor patients ineligible for transfemoral TAVI, alternative access routes are available, offering diverse strategies for treatment.

Researchers conducted a retrospective study to assess the utilization and patient outcomes of transaxillary (TAx), transapical (TA), and transaortic (TAo) access for TAVI in Germany, with a specific focus on comparing surgical cutdown vs. percutaneous TAx access.

They analyzed all patients enrolled in the German Aortic Valve Registry (GARY) from 2011 to 2019 who underwent non-transfemoral TAVI, comparing those who received TA, TAo, or TAx access using a weighted propensity score model. A subgroup analysis was conducted for TAx, examining the percutaneous versus surgical cutdown approach.

The results showed that of 9,686 patients, non-transfemoral access was administered. Among them, 8918 patients (92.1%) underwent TA, 398 (4.1%) TAo, and 370 (3.8%) TAx approaches. Within the TAx subgroup, 141 patients (38.1%) underwent subclavian cutdown, while 200 (54.1%) experienced a percutaneous approach. Comparative analysis revealed that TA patients had a significantly lower 30-day survival rate than TAx patients (TA 90.92% vs. TAx 95.59%, P=0.006; TAo 92.22% vs. TAx 95.59%, P=0.102). No statistically significant differences were observed when comparing percutaneous and cutdown TAx approaches. A higher incidence of vascular complications was noted (TA 1.8%, TAo 2.4%, TAx 12.2%; P<.001), and the hospital length of stay was shorter after TAx access (TA 12.9 days, TAo 14.1 days, TAx 12 days; P< .001).

Investigators concluded that in patients unsuitable for TF-TAVI, TAx access may be preferable due to potentially better short-term and long-term survival than TA and TAo access, but heart teams should still consider alternative access options.

Source: link.springer.com/article/10.1007/s00392-024-02402-9