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| Survival after Transapical and Transarterial Aortic Valve Implantation: Talking about Two Different Patient Populations | |
Sabine Bleiziffer, Hendrik Ruge, Domenico Mazzitelli, Christian Schreiber, Andrea Hutter, Robert Bauernschmitt, Ruediger Lange; Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
Methods: Between 06/2007 and 09/2008, 153 high-risk patients (EuroScore 24±14%, mean age 81±8y) underwent transcatheter aortic valve implantation transapically (n=27) or transarterially (n=123 transfemoral, n=3 via subclavian artery). The transapical implantation technique was chosen only in patients who had no access through diseased femoral or subclavian arteries. Results: 30-day survival was 89.9% after transarterial vs 79.1% after transapical implantation (p=0.028, see survival curve). The transapical group had a significantly higher preoperative BNP value, and a significantly higher incidence of peripheral vessel and cerebrovascular disease, pulmonary hypertension, and atrioventricular valve regurgitation. Death was valve-related in 25% (transapical) and 29% (transarterial), cardiac in 13% and 10%, and non-cardiac in 63% and 62%, respectively (n.s.). In the transapical group, there were significantly less postoperative vascular complications (4% vs 20%, p=0.009), and no neurological events (0% vs 6.5%, n.s.). Conclusion: Survival is worse in patients in whom transapical, as opposed to transarterial aortic valve implantation is necessary, because these patients exhibit a significantly higher incidence of comorbidities. The causes of death were not different in the two groups, however, more patients in the transapical group succumb during follow-up. On the other hand, cerebrovascular complications did not occur in patients with transapical access. 
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