• Arturo Giordano, Andreas Schaefer, Oliver D Bhadra, Lenard Conradi, Dirk Westermann, Ole DE Backer, Vilhelmas Bajoras, Lars Sondergaard, Waqas T Qureshi, Nikolaos Kakouros, Summer Aldrugh, Ignacio Amat-Santos, Sandra Santos Martínez, Tsuyoshi Kaneko, Morgan Harloff, Rui Teles, Tiago Nolasco, Jose P Neves, Miguel Abecasis, Nikos Werner, Michael Lauterbach, Jerzy Sacha, Krzysztof Krawczyk, Carlo Trani, Enrico Romagnoli, Antonio Mangieri, Francesco Condello, Ander Regueiro, Salvatore Brugaletta, Fausto Biancari, Matti Niemelä, Francesco Giannini, Marco Toselli, Rossella Ruggiero, Andrea Buono, Diego Maffeo, Francesco Bruno, Federico Conrotto, Fabrizio D'Ascenzo, Mikko Savontaus, Jouni Pykäri, Alfonso Ielasi, Maurizio Tespili, Nicola Corcione, Paolo Ferraro, Alberto Morello, Michele Albanese, and Giuseppe Biondi-Zoccai.
• Unit of Interventional Cardiology, Pineta Grande Hospital, Castel Volturno, Caserta, Italy.
• Panminerva Med. 2022 Dec 1; 64 (4): 427437427-437.

BackgroundTranscatheter aortic valve implantation (TAVI) is an established management strategy for severe aortic valve stenosis. Percutaneous axillary approach for TAVI holds the promise of improving safety without jeopardizing effectiveness in comparison to surgical access. We aimed at appraising the comparative effectiveness of percutaneous vs. surgical axillary approaches for TAVI.MethodsWe performed an international retrospective observational study using de-identified details on baseline, procedural, and 1-month follow-up features. Valve Academic Research Consortium (VARC)-3 criteria were applied throughout. Outcomes of interest were clinical events up to 1 month of follow-up, compared with unadjusted and propensity score-adjusted analyses.ResultsA total of 432 patients were included, 189 (43.8%) receiving surgical access, and 243 (56.2%) undergoing percutaneous access. Primary hemostasis failure was more common in the percutaneous group (13.2% vs. 4.2%, P<0.001), leading to more common use of covered stent implantation (13.2% vs. 3.7%, P<0.001). Irrespectively, percutaneous access was associated with shorter hospital stay (-2.6 days [95% confidence interval: -5.0; -0.1], P=0.038), a lower risk of major adverse events (a composite of death, myocardial infarction, stroke, type 3 bleeding, and major access-site related complication; odds ratio=0.44 [0.21; 0.95], P=0.036), major access-site non-vascular complications (odds ratio=0.21 [0.06; 0.77], P=0.018), and brachial plexus impairment (odds ratio=0.16 [0.03; 0.76], P=0.021), and shorter hospital stay (-2.6 days [-5.0; -0.1], P=0.038).ConclusionsPercutaneous axillary access provides similar or better results than surgical access in patients undergoing TAVI with absolute or relative contraindications to femoral access.

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