Transapical and transfemoral aortic valve implantation: Operative outcome in 180 consecutive patients

Détails

Ressource 1Télécharger: BIB_840DD1DC398C.P001.pdf (791.75 [Ko])
Etat: Public
Version: Après imprimatur
ID Serval
serval:BIB_840DD1DC398C
Type
Mémoire
Sous-type
(Mémoire de) maîtrise (master)
Collection
Publications
Institution
Titre
Transapical and transfemoral aortic valve implantation: Operative outcome in 180 consecutive patients
Auteur(s)
KELLER S
Directeur(s)
FERRARI E
Détails de l'institution
Université de Lausanne, Faculté de biologie et médecine
Statut éditorial
Acceptée
Date de publication
2015
Langue
anglais
Nombre de pages
33
Résumé
Objectives
The new Transcatheter Aortic Valve Replacement (TAVR) represents a valid alternative to the standard surgical approach for the treatement of aortic stenosis in patients with prohibitive surgical risk, and at the moment, the two main access routes employed are transapical and transfemoral TAVR. Aim of the study is to compare the outcome of 180 consecutive patients who underwent transapical and transfemoral aortic valve procedures.
Method
From 2008 to 2014, 180 consecutive patients underwent transapical (90 patients) or transfemoral (90 patients) TAVR procedures at our institute. Preoperative, intraoperative and postoperative variables were retrospectively collected and analysed to identify risk factors for mortality, vascular and neurological complications. Surgical outcomes were compared.
Results
Mean age was 80±8.5 years and 83±8.4 years, in the TA and TF group, respectively. TA- TAVR group presented a higher prevalence of comorbidities with more peripheral vascular disease, COPD, previous vascular surgery, coronary disease, previous coronary surgery and previous cardiac surgery.
The logistic Euroscore I was 36±15% in the TA group and 25±14% in the TF group (p<0.001).
Hospital mortality was similar (TA: 9%, TF: 10%, p=0.799) and early extubation seems to be a protective factor against hospital mortality (p=0.001). Access related vascular complications occurred more often in TF (TA: 3%, TF: 11%, p=0.081) whereas major or life threatening bleeding (TA: 3%, TF: 4%, p=1) and major stroke (TA: 2%, TF: 3%, p=1) were equally distributed. Postoperative acute renal failure and the need for a postoperative dialysis was associated with impaired neurological outcome (respectively p=0.035 and p=0.020). Paravalvular leaks (degree 2-4) were more prevalent in TF patients (TA: 6%, TF: 26%, p<0.001).
Conclusion
The TF and the TA TAVR groups include two different patients' risk profiles (the TA being at higher risk) but mortality rate and adverse neurological outcome have a similar incidence. The transfemoral approach carries a higher risk of vascular complications and paravalulvar leaks (degree 2 or greater).
Mots-clé
Transcatheter aortic valve replacement, Aortic valve stenosis, Transfemoral aortic valve replacement, Transapical aortic valve replacement.
Création de la notice
31/08/2016 12:37
Dernière modification de la notice
20/08/2019 14:43
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