Introduction Though transfemoral (TF) access has emerged as a gold standard access for patients with aortic stenosis who undergo transcatheter aortic valve implantation (TAVI), there has been no study that has characterized patients who cannot undergo TF access in detail. We aim to evaluate the contraindications for TF access, their incidence, classify them, and provide the outcomes of patients who failed to be TF candidates.

Methods From 925 patients who underwent TAVI between February 2014 and May 2020 at our heart center, 130 patients failed to be TF candidates and underwent transapical-transcatheter aortic valve implantation (TA-TAVI). In this study, we included all those patients who failed to be TF candidates and underwent TA-TAVI using the third-generation balloon expandable valve (Edwards SAPIEN 3 valve [S3]) (116 patients; STS score 6.07 ± 4.4; age 79.4 ± 7).

Results The incidence of patients unsuitable for TF access at our heart center was 14%. We classified this TAVI population into absolute contraindication for TF access n = 84 (72.5%) and increased interventional risk for TF access n = 32 (27.5%). After TA-TAVI of this specific population using S3, the in-hospital mortality and stroke were 1.7 and 1.7%, respectively. The vascular injury rate was 1.7%. We registered no paravalvular leakage ≥2. The pacemaker rate was 7.4%. The mean transvalvular pressure gradient was 8.7 mm Hg.

Conclusion The incidence of patients who cannot undergo TF access or who are at high interventional risk is considerably high. TA-TAVI, supported with sufficient interventional experience and appropriate valve system, represents an excellent alternative for patients with distinct vasculopathy.

引言 尽管经股动脉 (TF) 通路已成为接受经导管主动脉瓣植入 (TAVI) 的主动脉瓣狭窄患者的金标准通路，但尚无研究对无法接受 TF 通路的患者进​​行详细描述。我们旨在评估 TF 访问的禁忌症、其发生率、对其进行分类，并提供未能成为 TF 候选者的患者的结果。

方法 从 2014 年 2 月至 2020 年 5 月在我们心脏中心接受 TAVI 的 925 例患者中，130 例患者未能成为 TF 候选者并接受了经心尖经导管主动脉瓣植入术（TA-TAVI）。在这项研究中，我们纳入了所有未能成为 TF 候选者并使用第三代球囊扩张瓣膜（Edwards SAPIEN 3 瓣膜 [S3]）接受 TA-TAVI 的患者（116 名患者；STS 评分 6.07 ± 4.4；年龄 79.4 ± 7）。

结果 我们心脏中心不适合TF接入的患者发生率为14%。我们将这一 TAVI 人群分类为 TF 通路的绝对禁忌症n  = 84 (72.5%) 和 TF 通路的介入风险增加n  = 32 (27.5%)。使用 S3 对该特定人群进行 TA-TAVI 后，住院死亡率和卒中分别为 1.7% 和 1.7%。血管损伤率为1.7%。我们没有记录到瓣周漏≥2。起搏器率为 7.4%。平均跨瓣压梯度为 8.7 mm Hg。

结论 不能接受TF通路或高介入风险的患者发生率相当高。TA-TAVI 以足够的介入经验和适当的瓣膜系统为支持，代表了患有明显血管病变的患者的绝佳选择。