Transapical approach versus transcervical approach for transcatheter aortic valve replacement: a retrospective monocentric study.

Details

Serval ID
serval:BIB_0CE093BF76B9
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Transapical approach versus transcervical approach for transcatheter aortic valve replacement: a retrospective monocentric study.
Journal
Interactive cardiovascular and thoracic surgery
Author(s)
Lu H., Fournier S., Namasivayam J., Roguelov C., Ferrari E., Eeckhout E., Monney P., Tozzi P., Marcucci C., Muller O., Kirsch M.
ISSN
1569-9285 (Electronic)
ISSN-L
1569-9285
Publication state
Published
Issued date
07/12/2020
Peer-reviewed
Oui
Volume
31
Number
6
Pages
781-788
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Transfemoral approach is the standard access-route for transcatheter aortic valve replacement (TAVR). However, alternative approaches are needed in a number of patients and accesses such as transapical (TA) TAVR or transcervical (TC) are used. We aimed to compare clinical and echocardiographic outcomes after TA-TAVR or TC-TAVR.
All patients who underwent TA- and TC-TAVR for severe aortic stenosis in our institution between 2008 and 2020 were retrospectively included. End points included 30-day all-cause mortality, procedural complications (according to the Valve Academic Research Consortium-2 criteria), procedure duration, intensive care unit (ICU) length of stay (LOS) and overall hospital LOS. For 30-day all-cause mortality, we furthermore used a Cox proportional-hazards model to adjust for significant between-group differences in baseline characteristics as well as difference in year of intervention.
TAVR was performed in 176 patients, using a TA approach (n = 127) or a TC approach (n = 49). Baseline clinical and echocardiographic characteristics were comparable between the 2 groups, except age and peripheral artery disease. All-cause 30-day mortality rates were not significantly different (8.5% in the TA group vs 2.3% in the TC group, P = 0.124). TC approach was associated with significantly shorter procedure duration {71.0 [interquartile range (IQR) 52.5-101.0] vs 93 [IQR 80.0-120.0] min, P < 0.001}, shorter ICU LOS [0.0 (IQR 0.0-0.0) vs 1.0 (IQR 1.0-3.0) days, P < 0.001] and shorter hospital LOS [7.0 (IQR 5.0-9.5) vs 14.0 (IQR 10.0-22.0) days, P < 0.001].
The TC approach may be a good first-choice alternative in case of contraindications to transfemoral-TAVR.
Keywords
Aortic valve stenosis, Transapical, Transcatheter aortic valve replacement, Transcervical
Pubmed
Web of science
Create date
26/10/2020 13:58
Last modification date
04/02/2021 7:25
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