Alternate accesses for transcatheter aortic valve replacement: a retrospective single-center study

Background: Aortic stenosis is the most common valvular heart disease among elderly patients. Transcatheter aortic valve replacement has become a revolutionary treatment practice, utilizing various access options, including transfemoral, transaortic, transapical, and other alternatives. The choice of access significantly impacts the safety and outcomes of the procedure. Objective: The study was aimed to analyze the immediate and long- term outcomes on adoption of transapical and transaortic accesses in aortic valve replacement using the domestic MedLab-KT prosthesis. Methods: From June 2018 to September 2025, 66 transcatheter aortic valve replacement surgeries were performed via transapical and transaortic approaches using the “MedLab-KT” prosthesis, including 4 repeat procedures for dysfunction of the biological aortic valve prosthesis by the valve-in-valve technique. A retrospective analysis of the results was conducted, assessing preoperative, intraoperative, and early and late postoperative data. Criteria for technical success, device success, and early safety were assessed. Patients were divided into groups according to time intervals, namely 2018–2021 and 2022–2025, to evaluate the impact of accumulated experience on immediate and long-term surgical outcomes. Results: Intraoperative mortality was recorded in a single case (1.6 %). The rate of 30-day mortality was 9 % (6 patients). The aortic valve implantation procedure was technically successful in 62 cases (93.9 %). Device success was recorded in 56 patients (84.9 %). The early safety rate was 83.3 %. The average follow-up period was 3.5 years. With the accumulation of experience, the early safety rate increased by 15 % but no significant difference was revealed. The rate of 5-year freedom from reoperations was 100 %; 5-year survival rate was 87.9 %. Moreover, 5-year freedom from valve dysfunction was 97.5 % (95 % CI 0.92; 1). Conclusion: The results of this study demonstrate the efficacy and safety of the transapical and transaortic approaches in transcatheter aortic valve replacement using the domestic prosthesis “MedLab-KT”, which demonstrates satisfactory hemodynamic characteristics for the mid-late postoperative period. Analysis of the immediate and long- term results allows us to recommend the transaortic and transapical approaches as alternatives when the transfemoral approach is not possible.