Impact of transfemoral versus transapical access on mortality among patients with severe aortic stenosis undergoing transcatheter aortic valve replacement.
Impact of transfemoral versus transapical access on mortality among patients with severe aortic stenosis undergoing transcatheter aortic valve replacement.
- 2016
Available in print through MWHC library: 2002 - present
BACKGROUND: Studies have shown conflicting results regarding impact of access on outcome in severe aortic stenosis (AS) patients undergoing TAVR. CONCLUSIONS: Patients undergoing TAVR via TA have higher adjusted early mortality and similar late mortality rates compared to TF, despite higher risk profile. Copyright © 2016 Elsevier Inc. All rights reserved. METHODS: AS patients undergoing TAVR between May 2007-December 2014 were included. Baseline demographic, clinical, and imaging parameters were compared according to access, and landmark analysis models were generated to assess outcomes and associated factors. OBJECTIVE: To compare early and late mortality of transfemoral (TF) and transapical (TA) transcatheter aortic valve replacement (TAVR) patients and assess predictors for mortality. RESULTS: Among 648 severe AS patients undergoing TAVR, TF was used in 516 and TA in 132. Baseline characteristics between groups demonstrated lower body mass index, higher STS score, and rate of peripheral vascular disease among TA patients. Procedural complications were more common in the TA group, especially major bleeding (15% vs. 6%, p<0.001) and acute kidney injury >1 (8% vs. 1.4%, p<0.001). Landmark analysis demonstrated higher cumulative mortality rates at 30days among TA than TF patients (log-rank p<0.001), with similar mortality after 30days and up to 1-year (13% in both log-rank p=0.64). In a multivariate model, TA was an independent predictor of early mortality (HR=4.55 95% CI [12.5-1.6], p=0.003) along with pulmonary artery systolic pressure>60mmHg (HR=3.08 95% CI [7.37-1.29], p=0.01) and residual aortic regurgitation severity above mild (HR=3.99 95% CI [10.2-1.56], p=0.004).
English
1878-0938
*Aortic Valve
*Aortic Valve Stenosis/th [Therapy]
*Cardiac Catheterization/mt [Methods]
*Catheterization, Peripheral/mt [Methods]
*Femoral Artery
*Heart Valve Prosthesis Implantation/mt [Methods]
*Radial Artery
Aged
Aged, 80 and over
Aortic Valve Stenosis/dg [Diagnostic Imaging]
Aortic Valve Stenosis/mo [Mortality]
Aortic Valve Stenosis/pp [Physiopathology]
Aortic Valve/dg [Diagnostic Imaging]
Aortic Valve/pp [Physiopathology]
Cardiac Catheterization/ae [Adverse Effects]
Cardiac Catheterization/mo [Mortality]
Catheterization, Peripheral/ae [Adverse Effects]
Catheterization, Peripheral/mo [Mortality]
Chi-Square Distribution
District of Columbia
Female
Femoral Artery/dg [Diagnostic Imaging]
Heart Valve Prosthesis Implantation/ae [Adverse Effects]
Heart Valve Prosthesis Implantation/mo [Mortality]
Hospitals, High-Volume
Humans
Kaplan-Meier Estimate
Male
Multivariate Analysis
Proportional Hazards Models
Punctures
Radial Artery/dg [Diagnostic Imaging]
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
MedStar Heart & Vascular Institute
Comparative Study
Journal Article
Available in print through MWHC library: 2002 - present
BACKGROUND: Studies have shown conflicting results regarding impact of access on outcome in severe aortic stenosis (AS) patients undergoing TAVR. CONCLUSIONS: Patients undergoing TAVR via TA have higher adjusted early mortality and similar late mortality rates compared to TF, despite higher risk profile. Copyright © 2016 Elsevier Inc. All rights reserved. METHODS: AS patients undergoing TAVR between May 2007-December 2014 were included. Baseline demographic, clinical, and imaging parameters were compared according to access, and landmark analysis models were generated to assess outcomes and associated factors. OBJECTIVE: To compare early and late mortality of transfemoral (TF) and transapical (TA) transcatheter aortic valve replacement (TAVR) patients and assess predictors for mortality. RESULTS: Among 648 severe AS patients undergoing TAVR, TF was used in 516 and TA in 132. Baseline characteristics between groups demonstrated lower body mass index, higher STS score, and rate of peripheral vascular disease among TA patients. Procedural complications were more common in the TA group, especially major bleeding (15% vs. 6%, p<0.001) and acute kidney injury >1 (8% vs. 1.4%, p<0.001). Landmark analysis demonstrated higher cumulative mortality rates at 30days among TA than TF patients (log-rank p<0.001), with similar mortality after 30days and up to 1-year (13% in both log-rank p=0.64). In a multivariate model, TA was an independent predictor of early mortality (HR=4.55 95% CI [12.5-1.6], p=0.003) along with pulmonary artery systolic pressure>60mmHg (HR=3.08 95% CI [7.37-1.29], p=0.01) and residual aortic regurgitation severity above mild (HR=3.99 95% CI [10.2-1.56], p=0.004).
English
1878-0938
*Aortic Valve
*Aortic Valve Stenosis/th [Therapy]
*Cardiac Catheterization/mt [Methods]
*Catheterization, Peripheral/mt [Methods]
*Femoral Artery
*Heart Valve Prosthesis Implantation/mt [Methods]
*Radial Artery
Aged
Aged, 80 and over
Aortic Valve Stenosis/dg [Diagnostic Imaging]
Aortic Valve Stenosis/mo [Mortality]
Aortic Valve Stenosis/pp [Physiopathology]
Aortic Valve/dg [Diagnostic Imaging]
Aortic Valve/pp [Physiopathology]
Cardiac Catheterization/ae [Adverse Effects]
Cardiac Catheterization/mo [Mortality]
Catheterization, Peripheral/ae [Adverse Effects]
Catheterization, Peripheral/mo [Mortality]
Chi-Square Distribution
District of Columbia
Female
Femoral Artery/dg [Diagnostic Imaging]
Heart Valve Prosthesis Implantation/ae [Adverse Effects]
Heart Valve Prosthesis Implantation/mo [Mortality]
Hospitals, High-Volume
Humans
Kaplan-Meier Estimate
Male
Multivariate Analysis
Proportional Hazards Models
Punctures
Radial Artery/dg [Diagnostic Imaging]
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
MedStar Heart & Vascular Institute
Comparative Study
Journal Article