choice of access with transcatheter implantation of the aortic valve: results of a randomized trial of transfemoral and transapical methods

The study analyzed of the efficacy and safety of transfemoral (tf) and transapical (ta) approaches for transcatheter aortic valve implantation (tavi) in patients with severe aortic stenosis at high surgical risk. the prospective study included 270 patients (mean age 82.2±6.3 years), divided into tf (n=189) and ta (n=81) groups. the selection criteria included an aortic valve area <1 cm2, peak gradient >40 mmhg, and surgical risk >8 points. the preoperative examination included echocardiography, ct angiography, and an assessment of anatomical features. the procedure succeeded in 95.2% of cases without significant inter-group differences (p=0.34). the 30-day mortality rate was 5.9%, the stroke rate was 2.2%, without statistically significant differences between the groups (p>0.05). hemodynamic parameters improved after tavi: the average pressure gradient decreased to 12 mmhg, and the left ventricular ejection fraction increased to 59%. the quality of life (sf-36) improved by 45 points in the physical and 48 in the psychological components. nyha functional class iii-iv decreased from 79.6% to 12.1% after 30 days. transfemoral access correlated with a shorter period of hospitalization (5.2±1.8 days vs. 7.1±2.3 days for ta; p<0.01) and lower cost due to minimized rehabilitation costs. multifactorial analysis establizhed that the access choice did not influence survival yet was determined by the anatomy (calcification and vascular diameter) and the experience of the team. the results demonstrate similar effectiveness and safety of tf and ta approaches, validating the appropriateness of choice based on individual anatomical characteristics.