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

Détails

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Etat: Public
Version: Final published version
ID Serval
serval:BIB_BE3499DCAE7A
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Transfemoral versus transapical approach for transcatheter aortic valve implantation: hospital outcome and risk factor analysis.
Périodique
Journal of cardiothoracic surgery
Auteur(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
Statut éditorial
Publié
Date de publication
06/09/2017
Peer-reviewed
Oui
Volume
12
Numéro
1
Pages
78
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: epublish
Résumé
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.

Mots-clé
Aortic valve stenosis, Transapical aortic valve implantation, Transcatheter aortic valve implantation, Transfemoral aortic valve implantation
Pubmed
Web of science
Open Access
Oui
Création de la notice
21/09/2017 10:54
Dernière modification de la notice
20/08/2019 16:32
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