TCT-719 Alternative Access in transcatheter aortic valve replacement: Insight from Michigan Structural Heart Consortium

Document Type

Conference Proceeding

Publication Date

10-28-2025

Publication Title

J Am Coll Cardiol

Abstract

Background: Transfemoral access (TF) has emerged as the predominant default method for TAVR procedures, driven by notable advancements in technology and technique over recent years. However, around 5% of patients in the U.S. necessitate alternative access routes due to unfavorable iliofemoral vascular anatomy, particularly severe calcification or inadequate vessel size. The most frequently utilized alternative approaches include transfemoral TF, transaxillary (TAX), transcarotid (TC), and transcaval (TCV) access, while older methods such as transapical and direct transthoracic techniques have declined in use. Methods: We conducted a retrospective cohort study using data from the Michigan Structural Heart Consortium (MISHC), a statewide, multicenter quality improvement collaborative collecting detailed clinical data on structural heart procedures. Outcomes assessed included all-cause mortality, stroke, major bleeding, and length of hospital stay (LOS). Kaplan-Meier analyses assessed survival differences. Bayesian generalized linear mixed models adjusted for baseline demographics, clinical comorbidities, and hospital-level variability. Results: Among 18,405 consecutive TAVR procedures analyzed, access sites included transfemoral TF (97.5%), transcarotid (1.3%), transaxillary (0.6%), and transcaval (0.6%). Baseline Society of Thoracic Surgeon score was highest in transcaval TCV patients (p < 0.001). In-hospital mortality was highest among transcaval patients (p < 0.001). At 1 year, transaxillary access (odds ratio [OR]: 2.05, 95% Credible Interval [CI]: 1.19-3.40) and transcarotid access (OR: 1.90, 95% CI: 1.27-2.80), but not transcaval access, showed significantly increased odds of mortality compared to transfemoral TF access. TCV was not associated with higher mortality compared to TF. Kaplan-Meier analysis revealed significantly lower survival rates for non-transfemoral TF access than for transfemoral TF access (log-rank p< 0.001). Conclusion: Alternative access routes for TAVR, particularly transcaval and transaxillary T approaches, are associated with significantly higher risks than transfemoral TF access. These findings highlight the importance of careful patient selection and vigilant follow-up. Categories: STRUCTURAL: Valvular Disease and Intervention: Aortic

Volume

86

Issue

17

First Page

B314

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