Trans-subclavian versus transapical access for transcatheter aortic valve implantation: A multicenter study

Cristina Ciuca, Giuseppe Tarantini, Azeem Latib, Valeria Gasparetto, Carlo Savini, Marco Di Eusanio, Massimo Napodano, Francesco Maisano, Gino Gerosa, Alessandro Sticchi, Antonio Marzocchi, Ottavio Alfieri, Antonio Colombo, Francesco Saia

Research output: Contribution to journalArticle

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Abstract

Objectives To compare the outcomes of trans-subclavian (TS) and transapical (TA) access for transcatheter aortic valve implantation (TAVI). Background A considerable proportion of patients undergoing TAVI are not eligible for transfemoral approach. To date, there are few data to guide the choice between alternative vascular access routes. Methods Among 874 consecutive patients who underwent TAVI, 202 procedures were performed through TA (n = 142, 70.3%) or TS (n = 60, 29.7%) access. Medtronic Corevalve (CV, Medtronic, Minneapolis, MN) was implanted in 17.3% of the patients, the Edwards-Sapien (ES, Edwards Lifesciences Inc., Irvine, CA) in 81.2% and other prostheses in 0.1%. In-hospital and long-term outcome were assessed using the Valve Academic Research Consortium (VARC)-2 definitions. Results Mean age was 82 ± 6 years, STS score 9.3 ± 7.9%. The 2 groups showed a relevant imbalance in baseline characteristics. In hospital mortality was 6.4% (1.7% TS vs. 8.4% TA, P = 0.06), stroke 2.0%, acute myocardial infarction 1.0%, acute kidney injury 39.4%, sepsis 4.0% with no significant differences between groups, while bleeding was more frequent in TA patients (53.5% vs. 11.7% TS, P <0.001). One- and 2-year survival was 85.2% and 73.2% in TS patients, and 83.9% and 74.9% in TA patients (P = ns for both). Access site was not an independent predictor of mortality at multivariable analysis. Conclusion Transapical compared with trans-subclavian access for TAVI was associated with a nonsignificant trend to increased periprocedural events. However, 1- and 2-year survival appears similar.

Original languageEnglish
Pages (from-to)332-338
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume87
Issue number2
DOIs
Publication statusPublished - Feb 1 2016

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Multicenter Studies
Survival
Hospital Mortality
Acute Kidney Injury
Prostheses and Implants
Blood Vessels
Transcatheter Aortic Valve Replacement
Sepsis
Stroke
Myocardial Infarction
Hemorrhage
Mortality
Research

Keywords

  • aortic stenosis
  • outcome
  • transcatheter aortic valve replacement
  • vascular access

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Trans-subclavian versus transapical access for transcatheter aortic valve implantation : A multicenter study. / Ciuca, Cristina; Tarantini, Giuseppe; Latib, Azeem; Gasparetto, Valeria; Savini, Carlo; Di Eusanio, Marco; Napodano, Massimo; Maisano, Francesco; Gerosa, Gino; Sticchi, Alessandro; Marzocchi, Antonio; Alfieri, Ottavio; Colombo, Antonio; Saia, Francesco.

In: Catheterization and Cardiovascular Interventions, Vol. 87, No. 2, 01.02.2016, p. 332-338.

Research output: Contribution to journalArticle

Ciuca, C, Tarantini, G, Latib, A, Gasparetto, V, Savini, C, Di Eusanio, M, Napodano, M, Maisano, F, Gerosa, G, Sticchi, A, Marzocchi, A, Alfieri, O, Colombo, A & Saia, F 2016, 'Trans-subclavian versus transapical access for transcatheter aortic valve implantation: A multicenter study', Catheterization and Cardiovascular Interventions, vol. 87, no. 2, pp. 332-338. https://doi.org/10.1002/ccd.26012
Ciuca, Cristina ; Tarantini, Giuseppe ; Latib, Azeem ; Gasparetto, Valeria ; Savini, Carlo ; Di Eusanio, Marco ; Napodano, Massimo ; Maisano, Francesco ; Gerosa, Gino ; Sticchi, Alessandro ; Marzocchi, Antonio ; Alfieri, Ottavio ; Colombo, Antonio ; Saia, Francesco. / Trans-subclavian versus transapical access for transcatheter aortic valve implantation : A multicenter study. In: Catheterization and Cardiovascular Interventions. 2016 ; Vol. 87, No. 2. pp. 332-338.
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abstract = "Objectives To compare the outcomes of trans-subclavian (TS) and transapical (TA) access for transcatheter aortic valve implantation (TAVI). Background A considerable proportion of patients undergoing TAVI are not eligible for transfemoral approach. To date, there are few data to guide the choice between alternative vascular access routes. Methods Among 874 consecutive patients who underwent TAVI, 202 procedures were performed through TA (n = 142, 70.3{\%}) or TS (n = 60, 29.7{\%}) access. Medtronic Corevalve (CV, Medtronic, Minneapolis, MN) was implanted in 17.3{\%} of the patients, the Edwards-Sapien (ES, Edwards Lifesciences Inc., Irvine, CA) in 81.2{\%} and other prostheses in 0.1{\%}. In-hospital and long-term outcome were assessed using the Valve Academic Research Consortium (VARC)-2 definitions. Results Mean age was 82 ± 6 years, STS score 9.3 ± 7.9{\%}. The 2 groups showed a relevant imbalance in baseline characteristics. In hospital mortality was 6.4{\%} (1.7{\%} TS vs. 8.4{\%} TA, P = 0.06), stroke 2.0{\%}, acute myocardial infarction 1.0{\%}, acute kidney injury 39.4{\%}, sepsis 4.0{\%} with no significant differences between groups, while bleeding was more frequent in TA patients (53.5{\%} vs. 11.7{\%} TS, P <0.001). One- and 2-year survival was 85.2{\%} and 73.2{\%} in TS patients, and 83.9{\%} and 74.9{\%} in TA patients (P = ns for both). Access site was not an independent predictor of mortality at multivariable analysis. Conclusion Transapical compared with trans-subclavian access for TAVI was associated with a nonsignificant trend to increased periprocedural events. However, 1- and 2-year survival appears similar.",
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AU - Ciuca, Cristina

AU - Tarantini, Giuseppe

AU - Latib, Azeem

AU - Gasparetto, Valeria

AU - Savini, Carlo

AU - Di Eusanio, Marco

AU - Napodano, Massimo

AU - Maisano, Francesco

AU - Gerosa, Gino

AU - Sticchi, Alessandro

AU - Marzocchi, Antonio

AU - Alfieri, Ottavio

AU - Colombo, Antonio

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