MedStar Authors catalog › Details for: Impact of transfemoral versus transapical access on mortality among patients with severe aortic stenosis undergoing transcatheter aortic valve replacement.
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Impact of transfemoral versus transapical access on mortality among patients with severe aortic stenosis undergoing transcatheter aortic valve replacement.

by Koifman, Edward; Magalhaes, Marco; Kiramijyan, Starkis; Escarcega, Ricardo O; Didier, Romain; Torguson, Rebecca; Ben-Dor, Itsik; Corso, Paul J; Shults, Christian; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron.
Citation: Cardiovascular Revascularization Medicine. 17(5):318-21, 2016 Jul-Aug.Journal: Cardiovascular revascularization medicine : including molecular interventions.Published: 2016ISSN: 1878-0938.Full author list: Koifman E; Magalhaes M; Kiramijyan S; Escarcega RO; Didier R; Torguson R; Ben-Dor I; Corso P; Shults C; Satler L; Pichard A; Waksman R.UI/PMID: 27394178.Subject(s): Aged | Aged, 80 and over | Aortic Valve/dg [Diagnostic Imaging] | Aortic Valve/pp [Physiopathology] | *Aortic Valve | Aortic Valve Stenosis/dg [Diagnostic Imaging] | Aortic Valve Stenosis/mo [Mortality] | Aortic Valve Stenosis/pp [Physiopathology] | *Aortic Valve Stenosis/th [Therapy] | Cardiac Catheterization/ae [Adverse Effects] | *Cardiac Catheterization/mt [Methods] | Cardiac Catheterization/mo [Mortality] | Catheterization, Peripheral/ae [Adverse Effects] | *Catheterization, Peripheral/mt [Methods] | Catheterization, Peripheral/mo [Mortality] | Chi-Square Distribution | District of Columbia | Female | Femoral Artery/dg [Diagnostic Imaging] | *Femoral Artery | Heart Valve Prosthesis Implantation/ae [Adverse Effects] | *Heart Valve Prosthesis Implantation/mt [Methods] | 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] | *Radial Artery | Risk Assessment | Risk Factors | Severity of Illness Index | Time Factors | Treatment OutcomeInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Comparative Study | Journal ArticleDigital Object Identifier: https://dx.doi.org/10.1016/j.carrev.2016.05.002 (Click here) Abbreviated citation: Cardiovasc Revasc Med. 17(5):318-21, 2016 Jul-Aug.Local Holdings: Available in print through MWHC library: 2002 - present.Abstract: OBJECTIVE: To compare early and late mortality of transfemoral (TF) and transapical (TA) transcatheter aortic valve replacement (TAVR) patients and assess predictors for mortality.Abstract: BACKGROUND: Studies have shown conflicting results regarding impact of access on outcome in severe aortic stenosis (AS) patients undergoing TAVR.Abstract: 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.Abstract: 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).Abstract: CONCLUSIONS: Patients undergoing TAVR via TA have higher adjusted early mortality and similar late mortality rates compared to TF, despite higher risk profile.Abstract: Copyright © 2016 Elsevier Inc. All rights reserved.

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