Safety of Axillary and TransAortic Approaches for Transcatheter Aortic Valve Replacement in patients older than 85 years old: Results from Italian CoreValve Registry

Background: Trans-femoral (TF) approach represents the first choice of vascular access for transcatheter aortic valve replacement (TAVR). When not feasible, alternative approaches such as axillary artery (TA) or, more recently, direct ascending aorta (DA) are used for self-expandable valve implantation. Aim of this work was to evaluate the safety of TAVR with self-expandable valve through these alternative vascular approaches in 85 years old patients (pts). Methods: From the Clinical Service (former Italian CoreValve Registry) dataset, 1317 consecutive pts underwent TAVR with 3 generation CoreValve in 7 Italian sites between June 2007 and November 2012, were included in this analysis. Pts were divided into two groups according to the vascular access: TF or alternative approaches (TA and DA). Primary end point was the 30-day safety evaluation according to VARC-2 criteria. Results: Four hundred and eighty-four pts (37%) had an age 85 years (range, 85-99). TF access was used in 81% and alternative approaches in 19% of cases (16% TA and 2.5% DA). Sex female was higher in TF (64% vs 50%, respectively, p¼0.014) while the Logistic Euroscore I was higher in the second group (21% vs 26%,