Comparative Outcomes of Alternative Access Site Versus Lithotripsy-Assisted Transfemoral Transcatheter Aortic Valve Replacement: A Single-Center Retrospective Study.

Background: Transcatheter aortic valve replacement (TAVR) has emerged as a primary therapeutic option for patients with severe aortic stenosis across all surgical risk categories. Alternative access site (AAS) routes are often used in patients unsuitable for standard transfemoral (TF) approach, though intravascular lithotripsy (IVL) provides novel remedies to traditionally "unsuitable" patients. The objectives of our study were to compare outcomes between AAS TAVR placement and lithotripsy-assisted TF TAVR. Methods: The authors analyzed 60 patients who underwent TAVR between 2019 and 2022 (41 with alternative access, 19 with lithotripsy) at a single US site. Primary outcomes included procedural success, adverse events at 1 month and 1 year, length of stay, and 3-year mortality. Results: The data trended towards higher 1-month adverse outcomes in the alternative access patients compared to TF lithotripsy patients (17.1% (95% confidence interval (CI): 8.5% - 31.3%) vs. 0% (95% CI: 0.0% - 16.8%); P = 0.09), while 1-year adverse outcomes were similar (AAS 12.2% (95% CI: 5.3% - 25.5%) vs. IVL 15.8% (95% CI: 5.5% - 37.6%); P = 0.70), and 3-year mortality (19.5% vs. 21.1%) were similar between groups. Median length of stay was 3 days for both groups. Conclusions: Lithotripsy-assisted TF TAVR demonstrated a statistically insignificant trend toward short-term major adverse events with comparable 1-year morbidity and 3-year mortality to alternative access approaches. These findings may support lithotripsy as a viable option for patients with challenging vascular anatomy rather than the more traditional use of AAS in these settings. However, more extensive research is necessary for appropriate statistical power to prove superiority rather than equivocality alone.