Objectives: Subclavian (SC) and transapical (TA) approach are
the main alternatives to the default femoral delivery for transcatheter
aortic valve implantation (TAVI). Aim of this study was to compare,
complications and morbidity/mortality associated with SC and TA in a
long-term time frame. Methods: From January 2007 to July 2015,
1,506 patients underwent TAVI surgery in 36 United Kingdom TAVI centres.
Primary outcomes were complications according to VARC-2 criteria. The
secondary outcome was long-term survival. Results: The enrolled
patients were distributed as follows: 1,216 in the trans-apical (TA)
group and 290 in the subclavian (SC) group. There were no differences in
the rates of acute myocardial infarction, emergency valve-in-valve,
paravalvular leak, balloon post dilatation, cardiac tamponade, stroke,
renal replacement therapy, vascular injuries, and 30-days mortality
among the groups. Conversely, the rate of permanent pacemaker
implantation (p = 0.02), the procedural time duration (p = 0.04), and
the 12-month mortality (p = 0.03) was higher in SC than in TA, while
in-hospital length of stay was reduced in SC than in TA (p = 0.01). Up
to 8-years, the long-term mortality was not different among groups (p =
0.77), and no difference in long-term survival between self vs balloon
expandable device was found (p = 0.26). Conclusions: According
to our results, TA provided the best 12-months survival compared to SC,
while the long-term survival up to 2, 900 days is not significantly
different between groups, so SC and TA may both represent a safe
non-femoral access if femoral is precluded.
The STS score is the strongest predictor of long-term survival following transcatheter aortic valve implantation, whereas access route (transapical versus transfemoral) has no predictive value beyond the periprocedural phase