Early and midterm outcomes after transaxillar versus transfemoral TAVI. data from the spanish TAVI registry

Transaxillary access (TAx) has emerged as a less invasive alternative access when transfemoral access (TF) is not possible in patients undergoing TAVI. The primary endpoint of this study was to compare total in-hospital and 30-day mortality of patients included in the Spanish TAVI registry that were treated by TAx versus TF access. Methods All patients included in the Spanish TAVI registry who were treated by TAx or TF access were analyzed. In-hospital and 30-days outcomes were assessed using the Valve Academic Research Consortium definitions. An analyses by propensity score matching and multilevel logistic regression was performed for comparing both groups. Results A total of 6603 patients were included, of whom 191 (2.9%) were treated by TAx and 6412 were treated with TF access. After the adjustment, the device success was similar between both groups (94%, TAx vs 95%, TF p=0.95) as well as the rate of vascular complications (11.9% Tax vs 11.9 TF; p=0.78), bleeding (7.7% TAx vs. 7.9% TF; p=0.62) and stroke (4.2% TAx vs. 2.0 TF; p=0.09). However, in-hospital and 30-day mortality was significantly higher in TAx access group versus TF 2.19 (1.13–4.26): p=0.02 and 2.11 (1.08–4, 13); P=0.02, respectively. Similarly, the rate of acute myocardial infarction 5.05 (1.94–13.1); p=0.001, renal complications 2.07 (1.19–3.60; p =) 0.01 and pacemaker implantation 1.56 (1.01–2.40); p=0.04 was higher in the TAx group versus TF. Conclusions Transaxillary access compared to transfemoral access is associated with an increase in total in-hospital and 30-day mortality, as a result TAx access should be considered only in those cases in which TF is not possible Funding Acknowledgement Type of funding source: None