b'Scientific Session Abstracts SATURDAY APRIL 20, 2024 19: ALTERNATIVE ACCESS FOR TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR)Lili Sadri, MD, Donna Bahroloomi, MD, Ofir Koren, MD, Aakriti Gupta, MD, Rajendra Makkar, MD Ali Azizzadeh, MD, Donald Baril, MDCedars-Sinai Medical CenterObjectives: 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 TAVR patients 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). AA patients had higher stroke rates and 30-day mortality. When contemporary TAVR devices (2017-2021) were compared, however, there was no mortality difference between groups (table 2). Subgroup analysis of urgent TAVR procedures revealed that AA patients had significantly lower rates of major bleeding complications.Conclusion: AA allows for safe, minimally invasive aortic valve replacement. 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.56SOUTHERN CALIFORNIA VASCULAR SURGICAL SOCIETY'