BACKGROUND Surgical subclavian (SC) and direct aortic (DA) access are established alternatives to the default transfemoral route for transcatheter aortic valve implantation (TAVI). We sought to find differences in survival and procedure-related outcomes after SC- versus DA-TAVI. METHODS We performed an observational cohort analysis of cases prospectively uploaded to the UK TAVI registry. To ensure the most contemporaneous comparison, the analysis focused on SC and DA procedures performed from 2013 to 2015. RESULTS Between January 2013 and July 2015, 82 (37%) SC and 142 (63%) DA cases were performed that had validated 1-year life status. Multivariable regression analysis showed procedure duration was longer for SC cases (SC 193.5 ± 65.8 vs. DA 138.4 ± 57.7 min; p < .01) but length of hospital stay was shorter (SC 8.6 ± 9.5 vs. DA 11.9 ± 10.8 days; p = .03). Acute kidney injury was observed less frequently after SC cases (odds ratio [OR] 0.35, 95% confidence interval [CI 0.12-0.96]; p = .042) but vascular access site-related complications were more common (OR 9.75 [3.07-30.93]; p < .01). Procedure-related bleeding (OR 0.54 [0.24-1.25]; p = .15) and in-hospital stroke rate (SC 3.7% vs. DA 2.1%; p = .67) were similar. There were no significant differences in in-hospital (SC 2.4% vs. DA 4.9%; p = .49), 30-day (SC 2.4% vs. DA 4.2%; p = .71) or 1-year (SC 14.5% vs. DA 21.9%; p = .344) mortality. CONCLUSIONS Surgical subclavian and direct aortic approaches can offer favourable outcomes in appropriate patients. Neither access modality conferred a survival advantage but there were significant differences in procedural metrics that might influence which approach is selected.

中文翻译：

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通过锁骨下手术与直接主动脉通路经导管主动脉瓣植入术：英国的分析。

背景技术锁骨下（SC）和主动脉直接（DA）通路是经导管主动脉瓣植入（TAVI）的默认经股动脉途径的替代选择。我们试图找到SC-和DA-TAVI后生存率和与手术相关的结果的差异。方法我们对预期上传至英国TAVI注册中心的病例进行了观察性队列分析。为了确保最同时进行比较，分析着重于2013年至2015年执行的SC和DA程序。结果在2013年1月至2015年7月之间，进行了82例（37％）SC和142例（63％）DA病例，验证了1-年生活状态。多变量回归分析显示SC病例的手术时间更长（SC 193.5±65.8 vs. DA 138.4±57.7 min; p <.01），但住院时间较短（SC 8.6±9.5 vs. DA 11.9±10）。8天；p = .03）。SC病例后急性肾损伤的发生率较低（几率[OR] 0.35，95％置信区间[CI 0.12-0.96]； p = .042），但与血管通路部位相关的并发症更为常见（OR 9.75 [3.07- 30.93]； p <.01）。与手术相关的出血（OR 0.54 [0.24-1.25]； p = .15）和院内卒中发生率（SC 3.7％vs. DA 2.1％； p = .67）相似。住院期间（SC 2.4％vs. DA 4.9％； p = .49），30天（SC 2.4％vs. DA 4.2％； p = .71）或1年（SC 14.5）无显着差异。 ％vs. DA 21.9％； p ＝ 0.344）死亡率。结论锁骨下手术和直接主动脉入路可为适当的患者提供良好的治疗效果。两种访问方式均未赋予生存优势，但程序度量标准存在重大差异，可能会影响选择哪种方法。SC病例后急性肾损伤的发生率较低（几率[OR] 0.35，95％置信区间[CI 0.12-0.96]； p = .042），但与血管通路部位相关的并发症更为常见（OR 9.75 [3.07- 30.93]； p <.01）。与手术相关的出血（OR 0.54 [0.24-1.25]； p = .15）和院内卒中发生率（SC 3.7％vs. DA 2.1％； p = .67）相似。住院期间（SC 2.4％vs. DA 4.9％; p = .49），30天（SC 2.4％vs. DA 4.2％; p = .71）或1年（SC 14.5）没有显着差异。 ％vs. DA 21.9％； p ＝ 0.344）死亡率。结论锁骨下手术和直接主动脉入路可为适当患者提供良好的治疗效果。两种访问方式均未赋予生存优势，但程序度量标准存在重大差异，可能会影响选择哪种方法。SC病例后急性肾损伤的发生率较低（几率[OR] 0.35，95％置信区间[CI 0.12-0.96]； p = .042），但与血管通路部位相关的并发症更为常见（OR 9.75 [3.07- 30.93]； p <.01）。与手术相关的出血（OR 0.54 [0.24-1.25]； p = .15）和院内卒中发生率（SC 3.7％vs. DA 2.1％； p = .67）相似。住院期间（SC 2.4％vs. DA 4.9％； p = .49），30天（SC 2.4％vs. DA 4.2％； p = .71）或1年（SC 14.5）无显着差异。 ％vs. DA 21.9％； p ＝ 0.344）死亡率。结论锁骨下手术和直接主动脉入路可为适当患者提供良好的治疗效果。两种访问方式均未赋予生存优势，但程序度量标准存在重大差异，可能会影响选择哪种方法。