BACKGROUND: About one-third of candidates for transcatheter aortic valve implantation (TAVI) suffer from severe peripheral artery disease, making the routine femoral approach difficult or impossible. Aim was to compare the trans-axillary (TAx) and the trans-aortic (TAo) route for TAVI with Medtronic CoreValve Revalving System (CRS).
METHODS: 242 (23%) out of 1049 consecutive TAVI with 18F CRS were treated in 4 high-volume Italian Centre through TAx (61%) and TAo (39%).
RESULTS: The devices success was similar (p=0.16) with a trend to a lower incidence of significant paravalvular leak (6% vs 14%, p=0.07) and a significant reduction of permanent pacemaker (PPM) implantation (13% vs 34%, p=0.017) in the TAo. However, this route showed a higher incidence of acute kidney injury (p=0.016) and a longer hospital stay after the index procedure (days 10 [8-14] vs 8 [7-12], p=0.001). By a multivariate analysis the vascular access is an independent predictor for a longer hospital stay (TAo route; OR= 0.37, 95%CI 0.18-0.75; p=0.006) and for PPM implantation (TAx route; OR= 3.7, 95% CI 1.2-10.8; p=0.017).
CONCLUSION: Although the higher clinical risk profile of trans-aortic population, the TAo approach showed an equally high device success with similar 30-day safety and 1year efficacy, compared to TAx route. However, due to non procedure-specific complications post-TAo TAVI, this route requires a specialized postoperative care and the treatment of patients in highly specialized and experienced centres.
|Journal||Journal of Cardiovascular Surgery|
|Publication status||E-pub ahead of print - Oct 4 2016|
- Journal Article