Immediate and intermediate outcome after transapical versus transfemoral transcatheter aortic valve replacement

Fausto Biancari, Stefano Rosato, Paola D'Errigo, Marco Ranucci, Francesco Onorati, Marco Barbanti, Francesco Santini, Corrado Tamburino, Gennaro Santoro, Claudio Grossi, Remo Daniel Covello, Martina Ventura, Danilo Fusco, Fulvia Seccareccia

Research output: Contribution to journalArticle

Abstract

A few studies recently reported controversial results with transfemoral transcatheter aortic valve replacement (TF-TAVR) versus transapical transcatheter aortic valve replacement (TA-TAVR), often without adequate adjusted analysis for baseline differences. Data on patients who underwent TF-TAVR and TA-TAVR from the Observational Study of Effectiveness of avR-tavI procedures for severe Aortic stenosis Treatment study were analyzed with propensity score 1-to-1 matching. From a cohort of 1,654 patients (1,419 patients underwent TF-TAVR and 235 patients underwent TA-TAVR), propensity score matching resulted in 199 pairs of patients with similar operative risk (EuroSCORE II: TF-TAVR 8.1 ± 7.1% vs TA-TAVR, 8.4 ± 7.3%, p = 0.713). Thirty-day mortality was 8.0% after TA-TAVR and 4.0% after TF-TAVR (p = 0.102). Postoperative rates of stroke (TA-TAVR, 2.0% vs TF-TAVR 1.0%, p = 0.414), cardiac tamponade (TA-TAVR, 4.1% vs TF-TAVR 1.5%, p = 0.131), permanent pacemaker implantation (TA-TAVR, 8.7% vs TF-TAVR 13.3%, p = 0.414), and infection (TA-TAVR, 6.7% vs TF-TAVR 3.6%, p = 0.180) were similar in the study groups but with an overall trend in favor of TF-TAVR. Higher rates of major vascular damage (7.2% vs 1.0%, p = 0.003) and moderate-to-severe paravalvular regurgitation (7.8% vs 5.2%, p = 0.008) were observed after TF-TAVR. On the contrary, TA-TAVR was associated with higher rates of red blood cell transfusion (50.0% vs 30.4%, p = 0.0002) and acute kidney injury (stages 1 to 3: 44.4% vs 21.9%, p

Original languageEnglish
Pages (from-to)245-251
Number of pages7
JournalThe American Journal of Cardiology
Volume117
Issue number2
DOIs
Publication statusPublished - 2016

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Biancari, F., Rosato, S., D'Errigo, P., Ranucci, M., Onorati, F., Barbanti, M., Santini, F., Tamburino, C., Santoro, G., Grossi, C., Covello, R. D., Ventura, M., Fusco, D., & Seccareccia, F. (2016). Immediate and intermediate outcome after transapical versus transfemoral transcatheter aortic valve replacement. The American Journal of Cardiology, 117(2), 245-251. https://doi.org/10.1016/j.amjcard.2015.10.036