Background

There is an increasing need for alternative access in patients with prohibitive surgical risk who have unsuitable anatomy for transfemoral transcatheter aortic valve replacement (TAVR). Data on differences in periprocedural outcomes via alternative access sites are scarce.

Methods

We performed a retrospective analysis of patients who underwent Transaxillary (TAX) or Transapical (TAP) TAVR at our center from 2012 to 2019. All data was summarized and displayed as mean ± SD for continuous variables and number of patients in each group. A propensity score was created for each patient in the dataset to determine the probability of axillary vs apical access. We adjusted for propensity score using multivariate logistic regression.

Results

A total of 102 patients underwent TAVR via alternative access: 28 patients (27%) via transaxillary (TAX) and 74 patients (73%) via transapical (TAP) access. The average time to extubation in the TAX group was 5.3 ± 3.5 hours vs 9.1 ± 8.8 hours in the TAP patients (p = 0.03). None of the TAX patients required reintubation compared to 23% of TAP TAVR (p = 0.003).

The average hospital length of stay for TAX was 2.4 ± 2.0 days compared to 6.9 ± 3.3 days (p <0.0001) for TAP.

Conclusions

TAX TAVR patients had significantly lower re-intubation rates, shorter time to extubation and in-hospital length of stay, but higher pacemaker implantation rates. TAX TAVR had improved periprocedural outcomes compared to transapical TAVR and remains the preferred TAVR alternative access.

中文翻译：

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与经心尖TAVR相比，经腋窝TAVR可缩短呼吸机持续时间并缩短住院时间。

背景

对于解剖学不适合经股动脉经导管主动脉瓣置换术（TAVR）的，手术风险高昂的患者，越来越需要其他途径。缺乏关于通过其他途径获得的围手术期结果差异的数据。

方法

我们对2012年至2019年在我们中心接受了经腋下（TAX）或经心尖（TAP）TAVR的患者进行了回顾性分析。所有数据汇总并显示为连续变量和每组患者数的平均值±SD。为数据集中的每位患者创建一个倾向评分，以确定腋窝入路与根尖入路的概率。我们使用多元逻辑回归对倾向得分进行了调整。

结果

共有102例患者通过替代性途径接受TAVR：28例（27％）通过经腋（TAX）接受，74例（73％）通过经心尖（TAP）接受。TAX组的平均拔管时间为5.3±3.5小时，而TAP患者为9.1±8.8小时（p = 0.03）。与TAP TAVR的23％相比，没有TAX患者需要重新插管（p = 0.003）。

TAX的平均住院时间为2.4±2.0天，而TAP为6.9±3.3天（p <0.0001）。

结论

TAX TAVR患者的再插管率明显降低，拔管时间缩短，住院时间更长，但起搏器植入率更高。与经心尖TAVR相比，TAX TAVR改善了围手术期结局，仍然是首选的TAVR替代疗法。