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Am J Cardiol. 2016 Jan 15;117(2):245-51. doi: 10.1016/j.amjcard.2015.10.036. Epub 2015 Nov 6.

Immediate and Intermediate Outcome After Transapical Versus Transfemoral Transcatheter Aortic Valve Replacement.

Author information

1
Department of Surgery, Oulu University Hospital, Oulu, Finland.
2
National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy. Electronic address: stefano.rosato@iss.it.
3
National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
4
Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, IRCCS Policlinico San Donato, Milan, Italy.
5
Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
6
Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
7
Division of Cardiac Surgery, Institute for Treatment and Research University Hospital San Martino Scientific Institute for Tumours, Genova, Italy.
8
Division of Cardiology, Careggi Hospital, Firenze, Italy.
9
Division of Cardiac Surgery, Azienda Sanitaria Ospedaliera Santa Croce e Carle, Cuneo, Italy.
10
Department of Anesthesia and Intensive Care, Ospedale di Busto Arsizio, Varese, Italy.
11
Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.

Abstract

A few studies recently reported controversial results with transfemoral transcatheter aortic valve replacement (TF-TAVR) versus transapical transcatheter aortic valve replacement (TA-TAVR), often without adequate adjusted analysis for baseline differences. Data on patients who underwent TF-TAVR and TA-TAVR from the Observational Study of Effectiveness of avR-tavI procedures for severe Aortic stenosis Treatment study were analyzed with propensity score 1-to-1 matching. From a cohort of 1,654 patients (1,419 patients underwent TF-TAVR and 235 patients underwent TA-TAVR), propensity score matching resulted in 199 pairs of patients with similar operative risk (EuroSCORE II: TF-TAVR 8.1 ± 7.1% vs TA-TAVR, 8.4 ± 7.3%, p = 0.713). Thirty-day mortality was 8.0% after TA-TAVR and 4.0% after TF-TAVR (p = 0.102). Postoperative rates of stroke (TA-TAVR, 2.0% vs TF-TAVR 1.0%, p = 0.414), cardiac tamponade (TA-TAVR, 4.1% vs TF-TAVR 1.5%, p = 0.131), permanent pacemaker implantation (TA-TAVR, 8.7% vs TF-TAVR 13.3%, p = 0.414), and infection (TA-TAVR, 6.7% vs TF-TAVR 3.6%, p = 0.180) were similar in the study groups but with an overall trend in favor of TF-TAVR. Higher rates of major vascular damage (7.2% vs 1.0%, p = 0.003) and moderate-to-severe paravalvular regurgitation (7.8% vs 5.2%, p = 0.008) were observed after TF-TAVR. On the contrary, TA-TAVR was associated with higher rates of red blood cell transfusion (50.0% vs 30.4%, p = 0.0002) and acute kidney injury (stages 1 to 3: 44.4% vs 21.9%, p <0.0001) compared with TF-TAVR. Three-year survival rate was 69.1% after TF-TAVR and 57.0% after TA-TAVR (p = 0.006), whereas freedom from major adverse cardiovascular and cerebrovascular events was 61.9% after TF-TAVR and 50.4% after TA-TAVR (p = 0.011). In conclusion, TF-TAVR seems to be associated with significantly higher early and intermediate survival compared with TA-TAVR. The transfemoral approach, whenever feasible, should be considered the route of choice for TAVR.

PMID:
26639038
DOI:
10.1016/j.amjcard.2015.10.036
[Indexed for MEDLINE]

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