What is Transcatheter Aortic Valve Implantation (TAVI)?

Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive procedure designed to treat severe aortic stenosis. It's a less invasive alternative to traditional open-heart surgery, particularly beneficial for high-risk patients. The procedure involves the replacement of a narrowed aortic valve with a new one, improving blood flow and alleviating symptoms like chest pain and shortness of breath. The study explores the impact of the access route on TAVI outcomes.

What are the different access routes used in TAVI?

The two primary access routes for Transcatheter Aortic Valve Implantation (TAVI) are transfemoral (TF) and transapical (TA). The transfemoral approach accesses the heart through the femoral artery in the leg, making it less invasive. The transapical approach involves a small incision in the chest to directly access the heart. The choice between TF and TA depends on the patient's condition and the feasibility of the TF approach. The study aims to determine whether the access route affects patient outcomes and mortality rates in TAVI procedures.

Does the access route significantly affect mortality rates?

The study's findings suggest that the choice of access route, transfemoral (TF) or transapical (TA), may not directly impact mortality rates. The data indicates that the higher mortality sometimes observed with TA-TAVI might be due to the patient's risk profile. Patients undergoing TA-TAVI often have higher logistic EuroSCORE values, reflecting pre-existing conditions that make the TF approach unsuitable. The analysis emphasizes the importance of considering the patient's risk factors and the experience of the medical center when evaluating TAVI outcomes.

What is the significance of the logistic EuroSCORE in this context?

The logistic EuroSCORE is a measure used to assess a patient's risk before surgery, including Transcatheter Aortic Valve Implantation (TAVI). A higher EuroSCORE indicates a higher risk profile. The study found that the logistic EuroSCORE was an independent predictor of 30-day mortality in TAVI patients. This means that patients with higher EuroSCORE values, who often undergo transapical (TA-TAVI), are at greater risk regardless of the access route. The research highlights the significance of patient risk assessment in TAVI procedures.

TAVI access routes: Transfemoral and Transapical approaches

TAVI Access: Does the Route Really Matter?

Q: What was the study's methodology?

The study analyzed data from 1130 patients who underwent Transcatheter Aortic Valve Implantation (TAVI) between 2009 and 2016. The patients were divided into two groups based on their access route: transfemoral (TF-TAVI) and transapical (TA-TAVI). Researchers compared the 30-day mortality and major morbidity rates between these groups using the Valve Academic Research Consortium 2 (VARC-2) criteria. The goal was to determine whether the access route influenced patient outcomes. The analysis helps in guiding clinical decision-making by clarifying the factors influencing TAVI success.

Lena Kashyap in Health & Wellness December 2025 • 4 min read.

"A single-center study sheds light on whether transfemoral or transapical access impacts mortality in TAVI procedures."

Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of severe aortic stenosis, offering a less invasive alternative to traditional open-heart surgery for high-risk patients. While TAVI's benefits are clear, debates persist regarding the optimal access route—transfemoral (TF) or transapical (TA).

The transfemoral approach, accessing the heart through the femoral artery in the leg, is often preferred due to its minimally invasive nature. However, when TF isn't feasible, the transapical approach, which involves a small incision in the chest to access the heart directly, becomes necessary. Some studies have suggested that TA-TAVI is associated with higher mortality rates compared to TF-TAVI, raising concerns about whether the access route itself contributes to increased risk.

This article explores a recent single-center study that investigated the impact of access route on TAVI outcomes. By analyzing data from 1130 patients, researchers aimed to determine whether the increased mortality observed after TA-TAVI is truly caused by the access mode or if it reflects the higher-risk profile of patients undergoing this approach. This analysis helps to clarify the factors influencing TAVI success and guides clinical decision-making.

TAVI Access: Unpacking the Research

TAVI access routes: Transfemoral and Transapical approaches

The study, conducted at a single center, reviewed data from 1130 patients undergoing TAVI between 2009 and 2016. Of these, 619 patients underwent TF-TAVI, while 511 received TA-TAVI. Researchers meticulously compared 30-day mortality and major morbidity rates between the two groups, using the Valve Academic Research Consortium 2 (VARC-2) criteria to ensure standardized assessment.

The research team found that patients undergoing TA-TAVI often had a higher operative risk profile, as indicated by a higher logistic EuroSCORE (24% vs. 17% in TF-TAVI patients). This suggests that TA-TAVI was more frequently chosen for patients with pre-existing conditions or complications that made the TF approach less suitable.

Key findings from the study include:

Unadjusted 30-day mortality was higher in TA-TAVI patients, but this difference wasn't statistically significant.
Multivariate analysis revealed that the logistic EuroSCORE and institutional experience were independent predictors of 30-day mortality, while the access mode was not.
Major access-site complications occurred at similar rates in both groups.
After adjusting for risk factors, long-term mortality rates were also similar between TF-TAVI and TA-TAVI patients.

These results suggest that the increased mortality sometimes associated with TA-TAVI might not be directly caused by the access route itself. Instead, it appears to reflect the higher-risk profiles of patients undergoing this procedure and the overall experience of the medical center performing the TAVIs. As the center gained more experience, outcomes improved for both TF-TAVI and TA-TAVI patients.

The Bigger Picture: Patient Risk vs. Access Route

This study reinforces the importance of considering patient-specific risk factors when evaluating TAVI outcomes. While the transapical approach may be necessary for certain patients, it's crucial to recognize that these individuals often have more complex medical histories.

The study also highlights the impact of institutional experience on TAVI success. As medical centers perform more TAVI procedures, their teams become more skilled at patient selection, procedural techniques, and complication management, leading to improved outcomes regardless of the access route.

Ultimately, the choice between transfemoral and transapical TAVI should be based on a comprehensive assessment of the patient's individual needs and anatomical considerations, with careful attention to risk mitigation and optimization of procedural expertise. By focusing on these factors, healthcare professionals can ensure the best possible outcomes for all TAVI patients.