Comparative Outcomes of Alternative Access Site Versus Lithotripsy-Assisted Transfemoral Transcatheter Aortic Valve Replacement: A Single-Center Retrospective Study
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".