Objectives As an alternative to open aortic valve replacement, transcatheter aortic valve replacement (TAVR) is noninferior in outcomes. TAVR is mostly done via percutaneous transfemoral approach (TF). Alternative access (AA) via open carotid and axillary/subclavian, or transaortic, transapical, and transseptal via mini-sternotomy is considered in those with significant peripheral arterial disease or complex aortic anatomy. This study aims to compare baseline characteristics and outcomes in patients undergoing TF or AA TAVR. Methods A retrospective review of all patients undergoing TAVR between 2013 and 2021 was performed. Patients were divided into TF or AA TAVR groups and demographics, anatomy, and outcomes were compared. Subgroup analysis was performed for patients with elective vs. urgent TAVR procedures in both TF and AA groups. All AA patients were treated by either vascular or cardiac surgeons. Data was analyzed using SPSS 27. Results Between 2013 and 2021, 3421 patients underwent TAVR (3278= TF, 163= AA). AA patients were treated via axillary/subclavian (99), carotid (17), transaortic (31), transapical (9), and transseptal (2), respectively. AA patients were more likely to be male smokers with hypertension, diabetes, chronic kidney disease, ESRD, lung disease, coronary artery disease, and peripheral arterial disease (table 1), and had higher incidence of stroke and 30-day mortality (table 2). Subgroup analysis of urgent TAVR procedures revealed that AA patients had significantly lower rates of major bleeding complications. 30-day mortality for contemporary devices (those developed after 2017) was not statistically significant between TF and alternate access patients. Conclusion AA allows for safe, minimally invasive aortic valve replacement. AA patients had more baseline comorbidities, likely contributing to the higher rate of mortality compared to TF patients. With appropriate patient selection and meticulous perioperative planning and surgical technique, AA is a safe, acceptable approach for TAVR delivery with similar periprocedural and overall outcomes.
