Transcervical approach versus transfemoral approach for transcatheter aortic valve replacement.

Details

Serval ID
serval:BIB_9516A8F08ABE
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Transcervical approach versus transfemoral approach for transcatheter aortic valve replacement.
Journal
International journal of cardiology
Author(s)
Lu H., Monney P., Fournier S., Pavon A.G., Roguelov C., Eeckhout E., Muller O., Kirsch M.
ISSN
1874-1754 (Electronic)
ISSN-L
0167-5273
Publication state
Published
Issued date
15/03/2021
Peer-reviewed
Oui
Volume
327
Pages
58-62
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
The transfemoral (TF) approach is the gold-standard access route for transcatheter aortic valve replacement (TAVR). Alternative approaches, among which the transcervical (TC) approach, are needed in some patients. We aimed to compare TC-TAVR with TF-TAVR.
All patients who underwent TAVR in our institution between 2016 and 2020, using Edwards SAPIEN family balloon-expandable transcatheter heart valves, were retrospectively included. Endpoints included 30-day all-cause mortality, procedural complications (according to the VARC-2 criteria), procedure duration, hospital length of stay (LOS) and echocardiographic outcomes. 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 anesthesia modality.
TAVR was performed in 306 patients, using a TF approach (n = 255) or a TC approach (n = 51). TC-TAVR was associated with significantly higher STS scores (4.06 [IQR (interquartile range), 2.05, 5.56] vs. 2.97 [IQR, 2.08, 4.88], p < 0.001) and higher prevalence of peripheral artery disease, history of stroke, previous cardiovascular surgery. 30-day mortality (hazard ratio, 0.87 [0.77, 9.77], p = 0.909) and stroke rates (2.0% vs. 1.6%, p = 0.840) were similar, as well as procedural duration (74.0 [53.0, 99.5] vs. 77.0 [58.0, 98.0] minutes, p = 0.370), LOS (6.0 [IQR, 3.0, 8.0] vs. 6.0 [IQR, 4.0, 9.0] days, p = 0.175) and postprocedural mean transvalvular gradient (10.00 [IQR, 8.00, 13.00] vs. 10.00 [IQR, 8.00, 12.00] mmHg, p = 0.724).
Despite a higher cardiovascular disease burden in TC patients, TC-TAVR and TF-TAVR yielded similar outcomes. TC-TAVR may be a safe alternative when TF-TAVR is contraindicated.
Keywords
Aortic Valve/surgery, Aortic Valve Stenosis/diagnostic imaging, Aortic Valve Stenosis/surgery, Femoral Artery/diagnostic imaging, Femoral Artery/surgery, Heart Valve Prosthesis, Humans, Retrospective Studies, Risk Factors, Time Factors, Transcatheter Aortic Valve Replacement/adverse effects, Treatment Outcome, Aortic valve stenosis, Transcatheter aortic valve replacement, Transcervical, Transfemoral
Pubmed
Web of science
Open Access
Yes
Create date
07/12/2020 16:19
Last modification date
09/10/2021 6:38
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