Transfemoral versus transapical approach for transcatheter aortic valve implantation: hospital outcome and risk factor analysis.

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Serval ID
serval:BIB_BE3499DCAE7A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Transfemoral versus transapical approach for transcatheter aortic valve implantation: hospital outcome and risk factor analysis.
Journal
Journal of cardiothoracic surgery
Author(s)
Ferrari E., Eeckhout E., Keller S., Muller O., Tozzi P., Berdajs D., von Segesser L.K.
ISSN
1749-8090 (Electronic)
ISSN-L
1749-8090
Publication state
Published
Issued date
06/09/2017
Peer-reviewed
Oui
Volume
12
Number
1
Pages
78
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Transcatheter aortic valve implantation is indicated in high-risk patients with aortic stenosis. We compared the clinical outcome of 180 consecutive patients who underwent transapical (TA) and transfemoral (TF) procedures in a single centre.
Ninety consecutive TA (TA-group) and 90 consecutive TF (TF-group) were performed from 2009 to 2014. Clinical variables were prospectively collected and retrospectively analysed for hospital outcomes and to identify risk factors for hospital mortality, vascular complications and stroke.
Mean age was 80 ± 8.5 and 83 ± 8.4 years, in the TA and TF-group, respectively. TA-group presented higher prevalence of comorbidities: more vascular disease (79% vs 22%, p < 0.001), chronic pulmonary disease (32% vs 10%, p < 0.001), previous vascular surgery (14% vs 4%, p = 0.039), coronary disease (60% vs 40%, p = 0.007), and previous cardiac surgery (28% vs 17%, p = 0.073). Logistic Euroscore was 36 ± 15% in the TA-group and 25 ± 14% in the TF-group (p < 0.001), but hospital mortality was similar (TA:9%, TF:10%, p = 0.799). Access-related vascular complications occurred more often in transfemoral patients (TA:3%, TF:11%, p = 0.081) while major bleeding (TA:3%, TF:4%, p = 1) and stroke (TA:2%, TF:3%, p = 1) were equally distributed. Postoperative renal failure and dialysis were associated with impaired neurological outcome (p = 0.035 and p = 0.020, respectively). Mild to severe paravalvular leak was more prevalent in transfemoral patients (TA:5%, TF:25%, p < 0.001).
In our experience, the TA and TF-group presented different risk profiles but mortality rate and adverse neurological outcome had a similar incidence. The transfemoral approach carried more vascular complications and paravalvular leaks but last-generation devices will improve this outcome.

Keywords
Aortic valve stenosis, Transapical aortic valve implantation, Transcatheter aortic valve implantation, Transfemoral aortic valve implantation
Pubmed
Web of science
Open Access
Yes
Create date
21/09/2017 9:54
Last modification date
20/08/2019 15:32
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