A total of 489 TAVR patients were included in the study, with 302 (62%) femoral approach and 187 (38%) apical approach. With respect to demographics, the two groups were well matched, except those undergoing transapical TAVR had a higher incidence of peripheral arterial disease (PAD) and smoking history (Table 1).
Pre-procedurally, the two groups were similar, except those undergoing transfemoral TAVR more often had prior PPM and moderate/severe left ventricular outflow tract (LVOT) calcification (Table 2). Intra-procedurally, those undergoing transapical TAVR more frequently demonstrated malposition of the prosthesis (including low implantation depth) or required subsequent TAV-in-TAV deployment (Table 3).
In univariate analysis, the apical approach (when compared to the femoral approach) was associated with a higher incidence of both new onset LBBB (12.79 vs. 3.40%, p = 0.00007) and RBBB (5.49 vs. 1.5%, p = 0.01) (Fig. 1). After controlling for potential confounding variables, the apical approach continued to be associated with a higher incidence of both new onset LBBB (p = 0.001) and RBBB (p = 0.01) (Table 4). There was also a trend towards an association between diabetes and new-onset LBBB (p = 0.0513) in transapical TAVR patients.
In subgroup analysis, LBBB/RBBB occurring as a result of transapical TAVR was associated with more frequent hospitalizations > 30 days after TAVR, compared to transfemoral TAVR (Table 5).
Other post-procedural complications noted more frequently among patients undergoing transapical TAVR include arrhythmias including atrial fibrillation, peri-procedural myocardial infarction (within 72 h), mortality from unknown cause, and mortality from non-cardiac cause (Table 6).