Comparison of the Transarterial and Transthoracic Approaches in Nontransfemoral Transcatheter Aortic Valve Implantation

Transfemoral approach stands as the reference access-route for transcatheter aortic valve implantation (TAVI). Nonetheless, alternatives approaches are still needed in a significant proportion of patients. This study aimed at comparing outcomes between transthoracic-approach (transapical or transaor...

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Bibliographic Details
Published in:The American journal of cardiology 2019-05, Vol.123 (9), p.1501-1509
Main Authors: Beve, Mathurin, Auffret, Vincent, Belhaj Soulami, Reda, Tomasi, Jacques, Anselmi, Amedeo, Roisne, Antoine, Boulmier, Dominique, Bedossa, Marc, Leurent, Guillaume, Donal, Erwan, Le Breton, Hervé, Verhoye, Jean-Philippe
Format: Article
Language:English
Subjects:
Access routes
Aged
Aorta, Thoracic
Aortic valve
Aortic Valve - surgery
Aortic Valve Stenosis - surgery
Bleeding
Cardiac Catheterization - methods
Cardiology and cardiovascular system
Cardiovascular disease
Cause of Death - trends
Complications
Confidence intervals
Female
Femoral Artery
Follow-Up Studies
France - epidemiology
Heart attacks
Heart failure
Hospitals
Human health and pathology
Humans
Implantation
Incidence
Kidneys
Life Sciences
Lung diseases
Male
Mortality
Ostomy
Patients
Postoperative Complications - epidemiology
Regression analysis
Retrospective Studies
Statistical analysis
Stroke
Surgery
Tamponade
Time Factors
Transcatheter Aortic Valve Replacement - methods
Variables
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Summary:Transfemoral approach stands as the reference access-route for transcatheter aortic valve implantation (TAVI). Nonetheless, alternatives approaches are still needed in a significant proportion of patients. This study aimed at comparing outcomes between transthoracic-approach (transapical or transaortic) and transarterial-approach (transcarotid or subclavian) TAVI. Data from 191 consecutive patients who underwent surgical-approach TAVI from May 2009 to September 2017 were analyzed. Patients were allocated in 2 groups according to the approach. The primary end point was the 30-day composite of death of any cause, need for open surgery, tamponade, stroke, major or life-threatening bleeding, stage 2 or 3 acute kidney injury, coronary obstruction, or major vascular complications. During the study period, 104 patients underwent transthoracic TAVI (transapical: 60.6%, transaortic: 39.4%) whereas 87 patients underwent transarterial TAVI (subclavian: 83.9%, transcarotid: 16.1%). Logistic EuroSCORE I tended to be higher in transthoracic-TAVI recipients. In-hospital and 30-day composite end point rates were 25.0% and 11.5% (p = 0.025), and 26.0% and 14.9% (p = 0.075) for the transthoracic and transarterial cohorts, respectively. Propensity score-adjusted logistic regression demonstrated no significant detrimental association between the 30-day composite end point and transthoracic access (odds ratio 2.12 95% confidence interval 0.70 to 6.42; p = 0.18). Transarterial TAVI was associated with a shorter length of stay (median: 6 vs 7 days, p
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2019.01.040