{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T04:50:56Z","timestamp":1760244656384,"version":"build-2065373602"},"reference-count":16,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,11,28]],"date-time":"2022-11-28T00:00:00Z","timestamp":1669593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Objective: Transcatheter aortic valve replacement (TAVR) through alternative access routes is indicated in patients with severe aortic valve stenosis and diseased peripheral arteries. We analysed and compared the outcome of patients undergoing transapical (TA) and direct transaortic (TAO) TAVR procedures. Methods: Preoperative characteristics, procedural details, and thirty-day outcome of patients undergoing transapical (TA-TAVR group) and direct transaortic (TAO-TAVR group) TAVR procedures were prospectively collected and retrospectively analysed. Results: From March 2012 to March 2022, 81 TA and 82 TAO-TAVR (total: 163 cases) were performed with balloon-expanding (n = 120; 73.6%) and self-expandable (n = 43; 26.4%) valves. The mean age was 79.7 \u00b1 6.2 and 81.9 \u00b1 6.7 years for the TA- and TAO-TAVR groups, respectively (p = 0.032). Females were more represented in the TAO-TAVR group (56% vs. 32%; p = 0.003) while TA-TAVR patients showed a higher prevalence of previous vascular surgery (20% vs. 6%; p = 0.01), previous cardiac surgery (51% vs. 3.6%; p &lt; 0.001), and porcelain aorta (22% vs. 5%; p = 0.001). The mean ejection fraction was 49.0 \u00b1 14.6% (TA) and 53.5 \u00b1 12.2% (TAO) (p = 0.035) while mean gradients were 35.6 \u00b1 13.2 mmHg (TA) and 40.4 \u00b1 16.1 mmHg (TAO) (p = 0.045). The median EuroSCORE-II was 5.0% (IQR: 3.0\u201311.0) and 3.9% (IQR: 2.5\u20135.4) for the TA- and TAO-TAVR groups, respectively (p = 0.005). The procedural time was shorter for TA procedures (97 min (IQR: 882\u2013118) vs. 102 min (IQR: 88\u2013129); p = 0.133). Mortality at day 30 was 6% in both groups (p = 1.000); the permanent pacemaker implantation rate was similar (8.6% vs. 9.7%; p = 1.000), and hospital stay was shorter for the TAO group (8 days (IQR: 6\u201311) vs. 10 days (IQR: 7\u201313); p = 0.025). Conclusions: Our results show that transapical and direct transaortic TAVR in high-risk patients with diseased peripheral arteries provide satisfactory clinical results with similar thirty-day outcomes.<\/jats:p>","DOI":"10.3390\/jcdd9120422","type":"journal-article","created":{"date-parts":[[2022,11,29]],"date-time":"2022-11-29T01:42:02Z","timestamp":1669686122000},"page":"422","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ten-Year Experience with Transapical and Direct Transaortic Transcatheter Aortic Valve Replacement to Address Patients with Aortic Stenosis and Peripheral Vascular Disease"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2837-3242","authenticated-orcid":false,"given":"Enrico","family":"Ferrari","sequence":"first","affiliation":[{"name":"Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"},{"name":"Biomedical Faculty, University of Italian Switzerland (USI), 6900 Lugano, Switzerland"},{"name":"School of Medicine, University of Zurich, 8006 Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1184-7210","authenticated-orcid":false,"given":"Alberto","family":"Pozzoli","sequence":"additional","affiliation":[{"name":"Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0314-8548","authenticated-orcid":false,"given":"Catherine","family":"Klersy","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology & Biostatistics, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8489-3234","authenticated-orcid":false,"given":"Francesca","family":"Toto","sequence":"additional","affiliation":[{"name":"Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8706-8563","authenticated-orcid":false,"given":"Tiziano","family":"Torre","sequence":"additional","affiliation":[{"name":"Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9700-1584","authenticated-orcid":false,"given":"Tiziano","family":"Cassina","sequence":"additional","affiliation":[{"name":"Biomedical Faculty, University of Italian Switzerland (USI), 6900 Lugano, Switzerland"},{"name":"Cardiac Anaesthesia, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Pedrazzini","sequence":"additional","affiliation":[{"name":"Biomedical Faculty, University of Italian Switzerland (USI), 6900 Lugano, Switzerland"},{"name":"Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefanos","family":"Demertzis","sequence":"additional","affiliation":[{"name":"Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"},{"name":"Biomedical Faculty, University of Italian Switzerland (USI), 6900 Lugano, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,28]]},"reference":[{"key":"ref_1","unstructured":"Isselbacher, E.M., Preventza, O., Hamilton Black, J., Augoustides, J.G., Beck, A.W., Bolen, M.A., Braverman, A.C., Bray, B.E., Brown-Zimmerman, M.M., and Chen, E.P. 2022 ACC\/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J. Am. Coll. Cardiol., 2022. in press."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Francica, A., Benvegn\u00f9, L., San Biagio, L., Tropea, I., Battista Luciani, G., Faggian, G., and Onorati, F. Ten-year clinical and echocardiographic follow-up of third-generation biological prostheses in the aortic position. J. Thorac. Cardiovasc. Surg., 2022. in press.","DOI":"10.1016\/j.jtcvs.2022.10.023"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1161\/CIRCINTERVENTIONS.122.012388","article-title":"Lifetime Management of Aortic Stenosis: Transcatheter Versus Surgical Treatment for Young and Low-Risk Patients","volume":"15","author":"Russo","year":"2022","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1093\/ejcts\/ezs458","article-title":"Transapical aortic valve replacement in extreme-risk patients: Outcome, risk factors and mid-term results","volume":"43","author":"Ferrari","year":"2013","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1056\/NEJMoa1814052","article-title":"Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients","volume":"380","author":"Mack","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1016\/j.amjcard.2013.01.275","article-title":"Two-year outcomes for patients with severe symptomatic aortic stenosis treated with transcatheter aortic valve implantation","volume":"111","author":"Codner","year":"2013","journal-title":"Am. J. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1111\/j.1540-8183.2012.00729.x","article-title":"Acute and late outcomes of Transcatheter Aortic Valve Implantation (TAVI) for the treatment of severe symptomatic aortic stenosis in patients at high- and low-surgical risk","volume":"25","author":"Schymik","year":"2012","journal-title":"J. Intervent. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.ahj.2011.06.004","article-title":"Long-term quality of life improvement after transcatheter aortic valve implantation","volume":"162","author":"Georgiadou","year":"2011","journal-title":"Am. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1093\/ejcts\/ezy471","article-title":"The hospital results and 1-year outcomes of transcatheter aortic valve-in-valve procedures and transcatheter aortic valve implantations in native valves: Results from the Swiss-TAVI Registry","volume":"56","author":"Ferrari","year":"2019","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2717","DOI":"10.1016\/j.jacc.2021.02.038","article-title":"Valve Academic Research Consortium 3: Updated Endpoint Definitions for Aortic Valve Clinical Research","volume":"77","author":"Piazza","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"mmw011","DOI":"10.1093\/mmcts\/mmw011","article-title":"Transaortic transcatheter aortic valve replacement through a right mini-thoracotomy with balloon-expandable SapienTM 3 valve","volume":"2016","author":"Ferrari","year":"2016","journal-title":"Multimed. Man. Cardiothorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.1016\/j.athoracsur.2015.05.010","article-title":"Transapical and Transaortic Transcatheter Aortic Valve Replacement in the United States","volume":"100","author":"Thourani","year":"2015","journal-title":"Ann. Thorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.athoracsur.2015.03.039","article-title":"Transapical Versus Transaortic Transcatheter Aortic Valve Implantation: A Systematic Review","volume":"100","author":"Dunne","year":"2015","journal-title":"Ann. Thorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2320","DOI":"10.1016\/j.jcin.2016.08.009","article-title":"Direct Comparison of Feasibility and Safety of Transfemoral Versus Transaortic Versus Transapical Transcatheter Aortic Valve Replacement","volume":"9","author":"Arai","year":"2016","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_15","unstructured":"Costa, G., Saia, F., Pilgrim, T., Abdel-Wahab, M., Garot, P., Valvo, R., Gandolfo, C., Branca, L., Latib, A., and Santos, I.A. Transcatheter Aortic Valve Replacement with the Latest-Iteration Self-Expanding or Balloon-Expandable Valves: The Multicenter OPERA-TAVI Registry. JACC Cardiovasc. Interv., 2022. in press."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1055\/s-0037-1606356","article-title":"Heart-Team: Joint position of the Swiss society of cardiology and the Swiss society of cardiac surgery","volume":"65","author":"Pedrazzini","year":"2017","journal-title":"Thorac. Cardiovasc. Surg."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/9\/12\/422\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:28:43Z","timestamp":1760146123000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/9\/12\/422"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,28]]},"references-count":16,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["jcdd9120422"],"URL":"https:\/\/doi.org\/10.3390\/jcdd9120422","relation":{},"ISSN":["2308-3425"],"issn-type":[{"type":"electronic","value":"2308-3425"}],"subject":[],"published":{"date-parts":[[2022,11,28]]}}}