Objectives: Subclavian (SC) and transapical (TA) approach are the main alternatives to the default femoral delivery for transcatheter aortic valve implantation (TAVI). Aim of this study was to compare, complications and morbidity/mortality associated with SC and TA in a long-term time frame. Methods: From January 2007 to July 2015, 1,506 patients underwent TAVI surgery in 36 United Kingdom TAVI centres. Primary outcomes were complications according to VARC-2 criteria. The secondary outcome was long-term survival. Results: The enrolled patients were distributed as follows: 1,216 in the trans-apical (TA) group and 290 in the subclavian (SC) group. There were no differences in the rates of acute myocardial infarction, emergency valve-in-valve, paravalvular leak, balloon post dilatation, cardiac tamponade, stroke, renal replacement therapy, vascular injuries, and 30-days mortality among the groups. Conversely, the rate of permanent pacemaker implantation (p = 0.02), the procedural time duration (p = 0.04), and the 12-month mortality (p = 0.03) was higher in SC than in TA, while in-hospital length of stay was reduced in SC than in TA (p = 0.01). Up to 8-years, the long-term mortality was not different among groups (p = 0.77), and no difference in long-term survival between self vs balloon expandable device was found (p = 0.26). Conclusions: According to our results, TA provided the best 12-months survival compared to SC, while the long-term survival up to 2, 900 days is not significantly different between groups, so SC and TA may both represent a safe non-femoral access if femoral is precluded.

OBJECTIVE. For many years, functional tricuspid regurgitation (FTR) was considered negligible after treatment of left-sided heart valve surgery. The aim of the present network meta-analysis is to summarize the results of four approaches in order to establish the possible gold standard. METHODS A systematic search was performed to identify all publications reporting the outcomes of four approach for FTR, not tricuspid annuloplasty (no TA), suture annuloplasty (SA), flexible (FRA), rigid rings (RRA). All studies reporting at least one the four endpoints (early and late mortality, early and late moderate or more TFR) were included in a Bayesian network meta-analysis. RESULTS There were 31 included studies with 9,663 patients. Aggregate early mortality was 5.3% no TA, 7.2% SA, 6.6% FRA and 6.4% RRA; Early TR moderate-or-more was 9.6%, 4.8%, 4.6% and 3.8%; Late mortality was 22.5%, 18.2%, 11.9% and 11.9%; Late TR moderate-or-more was 27.9%, 18.3%, 14.3% and 6.4%. Rigid or semirigid ring annuloplasty was the most effective approach for decreasing the risk of late moderate or more FTR (–85% vs. no TA; –64% vs. SA; –32% vs. FRA). Concerning late mortality, no significant differences were found among different surgical approaches, however, flexible or rigid rings reduced significantly the risk of late mortality (78% and 47%, respectively) compared with not performing TA mortality. No differences were found for early outcomes. CONCLUSIONS. Ring annuloplasty seems to offer better late outcomes compare to either suture annuloplasty or not performing TA. In particular rigid or semirigid rings provides more stable FTR across time.